title: Frequency of inappropriate continuation of acid suppressive therapy after discharge in patients who began therapy in the surgical intensive care unit.
abstract: OBJECTIVE
  To determine the frequency with which patients who begin to receive stress ulcer prophylaxis in the surgical intensive care unit (SICU) are discharged receiving inappropriate acid suppressive therapy (AST).
  
  
  METHODS
  Prospective, observational evaluation. Setting. Level 1 trauma center and academic tertiary care hospital.
  
  
  METHODS
  A total of 248 consecutive adult patients admitted to the SICU during a 6-month period who began to receive AST with a proton pump inhibitor or histamine(2)-receptor antagonist.
  
  
  RESULTS
  In most patients (237 [95.6%] of 248), initiation of AST was associated with one or more risk factors for gastrointestinal bleeding. Continuation of AST during hospitalization outside the SICU occurred in 215 patients (86.7%). Sixty patients (24.2%) were discharged from the hospital receiving AST: 52 patients (21.0%) went to skilled nursing facilities or rehabilitation centers, and eight (3.2%) were discharged home. Compared with those whose AST was discontinued in the hospital, patients who continued to receive AST after hospital discharge required extended mechanical ventilation (p=0.001), had twice as many risk factors for gastrointestinal bleeding (p<0.001), were frequently discharged with anticoagulant therapy (p<0.001), exhibited longer hospital and SICU stays (p<0.001), and more frequently demonstrated Glasgow Coma Scale scores of 8 or lower and/or had head injury (p<0.001), hepatic failure (p=0.004), and major trauma (p=0.049). Evaluation of continuation of AST during hospitalization revealed that only 7.4% (16/215) of patients at SICU transfer and 5.0% (3/60) of patients at hospital discharge had a compelling risk factor to continue AST as demonstrated by a coagulopathy at discharge; no patients required mechanical ventilation at hospital discharge.
  
  
  CONCLUSIONS
  Most patients inappropriately continued to receive stress ulcer prophylaxis during post-SICU hospitalization. Presence of risk factors for stress ulcer-related gastrointestinal bleeding at SICU admission appears to influence continuation of AST after discharge from the hospital. A low percentage (3.2%) of patients was discharged home receiving inappropriate AST, yet overall, few study patients demonstrated a compelling risk factor for continuation of AST.
authors.affiliation: Department of Pharmacotherapy, Fletcher Allen Health Care, Burlington, Vermont, USA.
authors.forename: Catherine E
authors.initials: CE
authors.lastname: Murphy
authors.forename: Alison M
authors.initials: AM
authors.lastname: Stevens
authors.forename: Nicholas
authors.initials: N
authors.lastname: Ferrentino
authors.forename: Bruce A
authors.initials: BA
authors.lastname: Crookes
authors.forename: James C
authors.initials: JC
authors.lastname: Hebert
authors.forename: Carter B
authors.initials: CB
authors.lastname: Freiburg
authors.forename: Jill A
authors.initials: JA
authors.lastname: Rebuck
mesh_terms: D000328:Adult; D000368:Aged; D000897:Anti-Ulcer Agents / Q000627:therapeutic use*; D005260:Female; D006471:Gastrointestinal Hemorrhage / Q000209:etiology; D006801:Humans; D007362:Intensive Care Units; D008297:Male; D008875:Middle Aged; D010351:Patient Discharge; D010437:Peptic Ulcer / Q000517:prevention & control*; D011446:Prospective Studies; D012307:Risk Factors; D013315:Stress, Psychological / Q000150:complications*; D013514:Surgical Procedures, Operative
chemical_list: D000897:Anti-Ulcer Agents