Implementation of a clinical practice guideline for stress ulcer prophylaxis increases appropriateness and decreases cost of care.
OBJECTIVE
To develop, implement and evaluate a practice guideline for stress ulcer prophylaxis.


METHODS
Before-after study.


METHODS
Ten-bed Intensive Care Unit (ICU) and 4-bed Step-down Unit in a teaching hospital.


METHODS
Fifty patients admitted during 1 year before and 50 patients admitted 3-6 months after introduction of the guideline.


METHODS
Introduction of the practice guideline by dissemination of pocket cards, seminars and "academic detailing".


RESULTS
Appropriateness (defined as proportion of days in which the prophylaxis met the criteria in the guideline), incidence of gastrointestinal bleeding and of ventilator-associated pneumonia, length of stay in ICU and in hospital, ventilator days. ICU mortality and medication costs for stress ulcer prophylaxis. After the introduction of the guideline, appropriateness increased from 75.8% to 91.1%, and medication costs decreased from C $2.50/day to C $1.30/day. There were no differences in any clinical outcomes. Predictors of appropriate use or the withholding of prophylaxis were the introduction of the guideline, lack of an indication for prophylaxis and number of days studied.


CONCLUSIONS
Introduction of this guideline was associated with an increase in appropriateness of prophylaxis and a decrease in medication costs.
Pitimana-aree
S
S
St Paul's Hospital, Vancouver, B.C., Canada.
Forrest
D
D
Brown
G
G
Anis
A
A
Wang
X H
XH
Dodek
P
P
D000465:Algorithms; D003363:Cost Control; D003422:Critical Care / Q000191:economics / Q000379:methods*; D003663:Decision Trees; D005260:Female; D017721:Hospital Costs; D017052:Hospital Mortality; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D010437:Peptic Ulcer / Q000209:etiology / Q000517:prevention & control*; D017410:Practice Guidelines as Topic / Q000592:standards*; D013315:Stress, Psychological / Q000150:complications*; D016896:Treatment Outcome; D012122:Ventilators, Mechanical / Q000009:adverse effects