Impact of stress ulcer prophylaxis algorithm study.
BACKGROUND
In the intensive care unit at Royal Victoria Hospital, we noted that drugs prescribed for stress ulcer prophylaxis were not always indicated or optimal. Accordingly, we implemented an algorithm for stress ulcer prophylaxis to guide the medical team in their decisions. The agents selected for the algorithm were intravenous famotidine and omeprazole suspension or tablets, depending on the available administration route.


OBJECTIVE
To evaluate the impact of a treatment algorithm on the appropriateness of prescriptions for stress ulcer prophylaxis.


METHODS
A quasi-experimental-type evaluative study was conducted based on a pre-/post-intervention design without a concurrent control group. A total of 555 complete admissions met the selection criteria; 303 patients formed the pre-intervention group, and 252 made up the post-intervention group (exposed to the treatment algorithm).


RESULTS
After implementation of the algorithm, the proportion of inappropriate prophylaxis was decreased (95.7% vs 88.2%; p = 0.033). The number of days of inappropriate prophylaxis was also reduced significantly (p = 0.013), as was the cost per patient (p = 0.003) for all admissions. However, no difference was observed when the subgroup of patients who received prophylaxis alone was studied (p = 0.098 and p = 0.918). The presence of bleeding was similar in both groups.


CONCLUSIONS
Introduction by pharmacists of a treatment algorithm for stress ulcer prophylaxis in intensive care units allows a reduction of inappropriate prescriptions and thus a reduction in the cost of drugs. The use of omeprazole suspension seems to be an alternative to intravenous histamine2-inhibitors; however, a large-scale study is necessary to confirm the efficacy and safety of proton-pump inhibitors administered by an enteral tube.
Coursol
Christian J
CJ
Department of Pharmacy, Royal Victoria Hospital, McGill University Health Center, Montréal, Québec, Canada. christian.coursol@muhc.mcgill.ca
Sanzari
Sabrina E
SE
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000465:Algorithms; D000897:Anti-Ulcer Agents / Q000627:therapeutic use*; D004334:Drug Administration Schedule; D015738:Famotidine / Q000008:administration & dosage / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D007362:Intensive Care Units; D019934:International Normalized Ratio; D008297:Male; D008875:Middle Aged; D009853:Omeprazole / Q000008:administration & dosage / Q000627:therapeutic use*; D010437:Peptic Ulcer / Q000209:etiology / Q000517:prevention & control*; D012307:Risk Factors
D000897:Anti-Ulcer Agents; D015738:Famotidine; D009853:Omeprazole