Stress ulcer prophylaxis in pediatric intensive care units

Background: One of the complications of critical ill patients admitted to intensive care unit (ICU) are stress-related mucosal damage. Stress ulcer prophylaxis (SUP) should be administered to all critically ill patients with at least one major risk factor and two or more minor criteria. Methods: This study was performed during 6 months from October 2013 to December 2013 in Namazi Hospital intensive care units to assess the appropriate administration of SUP, according to American Society of Health-System Pharmacists (ASHP) protocol. Candidate for SUP according the ASHP guideline is considered if there is a at least one major risk factor or two or more minor risk factors. Results: Ninety-four patients were enrolled (46 men and 48 women). The mean age of study subjects was 51.5 years. The most major risk factor to stress ulcer found to be mechanical ventilation more than 48 hours (53%). The most minor risk factor for stress ulcer was ICU admission for less than one week (23.5%). Most prescribed medication for stress ulcer prophylaxis was intravenous Pantoprazole (44.7%). Our results have shown that about 74% patients were candidate for SUP according the ASHP guideline. 13(13.8%) of patients had only major risk factors. 5 (5.3%) of patients received SUP while they did not have at least one major risk factor or two or more minor risk factors. Conclusion: Our results have shown that 76.2% of the total SUP administrations were compliant with the ASHP guideline. Among the prescribed medication for SUP, intravenous pantoprazole had the highest percentage of administration (44.7%) and oral omeprazole had the lowest percentage of administration (7.4%). According to the results of our study, 72% of the route administrations are compliant with the ASHP guideline.

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A survey of stress ulcer prophylaxis in Intensive Care Units in the UK

Anaesthesia ◽

10.1111/j.1365-2044.2007.05050.x ◽

2007 ◽

Vol 62 (4) ◽

pp. 421-422 ◽

Cited By ~ 11

Author(s):

A. P. Gratrix ◽

S. M. Enright ◽

H. A. O'Beirne

Keyword(s):

Intensive Care ◽

Intensive Care Units ◽

Stress Ulcer ◽

Stress Ulcer Prophylaxis ◽

Ulcer Prophylaxis ◽

The Uk

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An Interprofessional Approach to Reducing the Overutilization of Stress Ulcer Prophylaxis in Adult Medical and Surgical Intensive Care Units

Annals of Pharmacotherapy ◽

10.1177/1060028013517088 ◽

2014 ◽

Vol 48 (4) ◽

pp. 462-469 ◽

Cited By ~ 11

Author(s):

Chelsea L. Tasaka ◽

Cindy Burg ◽

Sherilyn J. VanOsdol ◽

Lynne Bekeart ◽

Andrew Anglemyer ◽

...

Keyword(s):

Intensive Care ◽

Intensive Care Units ◽

Stress Ulcer ◽

Stress Ulcer Prophylaxis ◽

Surgical Intensive Care ◽

Ulcer Prophylaxis

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Clinical and economic benefits of de-escalating stress ulcer prophylaxis therapy in the intensive care unit: A quality improvement study

Anaesthesia and Intensive Care ◽

10.1177/0310057x19860972 ◽

2019 ◽

Vol 47 (6) ◽

pp. 503-509 ◽

Cited By ~ 1

Author(s):

Matthew H Anstey ◽

Edward Litton ◽

Robert N Palmer ◽

Sneha Neppalli ◽

Benedict J Tan ◽

...

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Quality Improvement ◽

Intensive Care Units ◽

Stress Ulcer ◽

Cost Savings ◽

Economic Benefits ◽

Stress Ulcer Prophylaxis ◽

Prescribing Patterns ◽

Ulcer Prophylaxis

Stress ulcer prophylaxis is commonly prescribed in the intensive care unit but can be inappropriately commenced or continued on discharge, exposing patients to potential harm. We aimed to evaluate whether a prescribing guideline, education program and pharmacist oversight would reduce inappropriate continuation of stress ulcer prophylaxis. This was a multicentre pre- (2014) and post- (2016) quality improvement study across five Australian intensive care units. Cost data were estimated using local information about prescribing patterns, and the relationship between long-term use and adverse events. A total of 531 patients were included in the pre- and 393 in the post-implementation periods. The proportion of hospital survivors inappropriately continued on stress ulcer prophylaxis reduced from 78/184 (42.4%) to 11/143 (7.7%) in the post-implementation period (odds ratio = 8.83; 95% confidence interval 4.47–17.45; P < 0.0001). Clostridium difficile–associated disease reduced from 10 patients to one in the pre- to post-implementation groups. The extrapolated direct savings to all Australian intensive care units from reduced proton pump inhibitor prescribing are relatively small (AUD$2.08 million/year), but the reduction in complications has both benefits for patients and indirect savings of AUD$16.59 million/year nationally. In patients admitted to the intensive care unit, the introduction of a simple, bundled intervention resulted in a significant decrease in inappropriate continuation of stress ulcer prophylaxis at hospital discharge and a reduction in recognised complications, and substantial cost savings.

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