title: Impact of a clinical pharmacist stress ulcer prophylaxis management program on inappropriate use in hospitalized patients.
abstract: OBJECTIVE
  Appropriate utilization of stress ulcer prophylaxis should be limited to high-risk, intensive care unit (ICU) patients. However, inappropriate stress ulcer prophylaxis use among all hospitalized patients remains a concern. The purpose of this study was to evaluate the clinical and economic impact of a novel pharmacist-managed stress ulcer prophylaxis program in ICU and general ward patients.
  
  
  METHODS
  This retrospective, pre- and poststudy design was conducted in adult ICU and general ward patients at a large academic medical center between January 1, 2011 and January 31, 2012 to compare the rates of inappropriate stress ulcer prophylaxis before and after the implementation of a pharmacist-led stress ulcer prophylaxis management program.
  
  
  RESULTS
  A total of 1134 unique patients consisting of 16,415 patient days were evaluated. The relative reduction in the rate of inappropriate stress ulcer prophylaxis days after program implementation in ICU and general ward patients was 58.3% and 83.5%, respectively (P < .001). The rates of ICU patients inappropriately continued on stress ulcer prophylaxis upon hospital discharge in the pre- and postimplementation groups were 29.9% and 3.6%, respectively (P < .001), whereas general ward patients significantly decreased from 36.2% to 5.4% in the pre- and postimplementation groups, respectively (P < .001). Total inpatient costs associated with all stress ulcer prophylaxis administered was $20,052.70 in the pre- and $3280.49 in the postimplementation group (P < .001), resulting in an estimated cost savings of > $200,000 annually. No differences in clinical outcomes were observed.
  
  
  CONCLUSIONS
  The implementation of a pharmacist-managed stress ulcer prophylaxis program was associated with a decrease in inappropriate acid suppression rates during hospitalization and upon discharge, as well as significant cost savings.
authors.affiliation: Banner-University Medical Center Phoenix, Phoenix, Ariz. Electronic address: mitchell.buckley@bannerhealth.com.
authors.forename: Mitchell S
authors.initials: MS
authors.lastname: Buckley
authors.affiliation: Banner-University Medical Center Phoenix, Phoenix, Ariz.
authors.forename: Andrew S
authors.initials: AS
authors.lastname: Park
authors.affiliation: Banner-University Medical Center Phoenix, Phoenix, Ariz.
authors.forename: Clint S
authors.initials: CS
authors.lastname: Anderson
authors.affiliation: Midwestern University-Glendale Campus, Glendale, Ariz.
authors.forename: Jeffrey F
authors.initials: JF
authors.lastname: Barletta
authors.affiliation: Banner-University Medical Center Phoenix, Phoenix, Ariz.
authors.forename: Dale S
authors.initials: DS
authors.lastname: Bikin
authors.affiliation: Banner-University Medical Center Phoenix, Phoenix, Ariz.
authors.forename: Richard D
authors.initials: RD
authors.lastname: Gerkin
authors.affiliation: Banner-University Medical Center Phoenix, Phoenix, Ariz.
authors.forename: Cheryl W
authors.initials: CW
authors.lastname: O'Malley
authors.affiliation: Banner-University Medical Center Phoenix, Phoenix, Ariz.
authors.forename: Laura M
authors.initials: LM
authors.lastname: Wicks
authors.affiliation: Banner-University Medical Center Phoenix, Phoenix, Ariz.
authors.forename: Roxanne
authors.initials: R
authors.lastname: Garcia-Orr
authors.affiliation: University of Pittsburgh School of Pharmacy, Pittsburgh, Pa.
authors.forename: Sandra L
authors.initials: SL
authors.lastname: Kane-Gill
mesh_terms: D000328:Adult; D000368:Aged; D000897:Anti-Ulcer Agents / Q000009:adverse effects / Q000191:economics / Q000627:therapeutic use*; D017046:Cost Savings; D006635:Histamine H2 Antagonists / Q000009:adverse effects / Q000191:economics / Q000627:therapeutic use; D006757:Hospital Units; D006760:Hospitalization; D006801:Humans; D057970:Inappropriate Prescribing; D007362:Intensive Care Units; D008875:Middle Aged; D010437:Peptic Ulcer / Q000517:prevention & control*; D010595:Pharmacists; D054328:Proton Pump Inhibitors / Q000009:adverse effects / Q000191:economics / Q000627:therapeutic use; D012189:Retrospective Studies; D013312:Stress, Physiological
chemical_list: D000897:Anti-Ulcer Agents; D006635:Histamine H2 Antagonists; D054328:Proton Pump Inhibitors
keywords: Acid suppression therapy; Clinical pharmacy; Histamine-2 receptor antagonist; Proton pump inhibitor; Stress ulcer prophylaxis