Impact of targeted educational interventions on appropriateness of stress ulcer prophylaxis in critically ill adults

Abstract

Background: Acid suppression therapy (AST) is routinely used in critically ill patients to prevent stress-related mucosal bleeding (SRMB).

Objective: Our objective was to determine the impact of a structured educational intervention on AST used for prevention of SRMB on appropriateness of AST.

Methods: A single-center, retrospective, cohort study of appropriate use of AST in critically ill patients admitted to the medical intensive care unit (ICU) at an academic medical center between January to June of 2014 (no intervention) and January to June of 2015 (intervention) was conducted. The percentage of patients prescribed inappropriate AST, inappropriate AST at ICU transfer and hospital discharge, doses of inappropriate AST, and adverse effects associated with AST use were compared between periods using chi-square tests.

Results: Patients in the intervention group (n=118) were 5 years older than patients in the no intervention group (n=101). AST was inappropriately initiated more frequently in the no intervention group (23% vs. 11%, p=0.012). Continuation of inappropriate AST at ICU transfer and hospital discharge was similar between groups (60% vs. 53%, p=0.277 and 18% vs. 14%, p=0.368, respectively).

Conclusion: Patients had appropriate AST initiated and inappropriate AST withheld more frequently when formal education was provided. This low-cost intervention strategy can be implemented easily at institutions where pharmacists interact with physicians on rounding services and should be evaluated in institutions where interactions between pharmacists and physicians occur more frequently in non-rounding situations.

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Author Biographies

Drayton A. Hammond

Assistant Professor of Pharmacy Practice

Catherine A. Killingsworth
Clinical Pharmacist
Jacob T. Painter
Assistant Professor of Pharmacy Practice
Rose E. Pennick
Clinical Pharmacist
Kshitij Chatterjee
Internal Medicine Resident
Bradley Boye
Internal Medicine and Pediatrics Resident
Nikhil Meena
Assistant Professor of Medicine

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Published
2017-09-03
How to Cite
HAMMOND, Drayton A. et al. Impact of targeted educational interventions on appropriateness of stress ulcer prophylaxis in critically ill adults. Pharmacy Practice, [S.l.], v. 15, n. 3, p. 948, sep. 2017. ISSN 1886-3655. Available at: <https://www.pharmacypractice.org/journal/index.php/pp/article/view/948>. Date accessed: 17 oct. 2017.
Section
Original Research

Keywords

Anti-Ulcer Agents; Inappropriate Prescribing; Intensive Care Units; Pharmacists; Academic Medical Centers; Retrospective Studies; United States