PURPOSE: Patients are usually more susceptible to stress ulcers during their Intensive Care Unit (ICU) stays. Our hypothesis is that despite recommendations, stress ulcer prophylaxis (SUP) is overused in the ICU’s and continued long past its need. We also hypothesize that advanced and specific education for house-staff will decrease this.
METHODS: Retrospective chart review was done in 2 six month phases. House staff education was done prior to phase2. The patients were divided into 4 groups, (1) ≥ 1 major risk factor (2) ≥ 1 Minor risk factor (3) 0 risk factors (4) patients already on acid suppressive medications. Rates of SUP were calculated for each group during ICU stay, on medicine floor and at discharge from the hospital. Group 4 data was excluded and will be analyzed separately.
RESULTS: 279 patients were admitted to the ICU, 132 were excluded from the study. Of group 1-3, 55.78% were placed on SUP. 27.71% of patients with no risk factors were placed on SUP, as were 88.88% and 91.3 % of patients with ≥1 major and minor risk factors respectively. 21.87% of patients were discharged on acid suppressive medication without a new indication.
CONCLUSION: SUP has been widely used in ICU patients at risk for stress related GI bleed. The Surviving Sepsis Campaign advocates SUP in severe sepsis, as patients have major risk factors (mechanical ventilation and coagulopathy) for stress ulcer bleeding2. Prophylaxis against stress ulcers, however, is expensive and may have adverse effects. There have been multiple reports of overuse of SUP in ICU and they should only be used when indicated3. Greater issue is discharge on acid suppressive medication without indication. We will have the data of the effect of house-staff education on the use of SUP (phase 2) in July 2010.
CLINICAL IMPLICATIONS: SUP overuse exposes patients to unneeded adverse effects and leads to increased healthcare costs. Education about SUP recommendations may decrease the overuse.
DISCLOSURE: Nikhil Meena, No Financial Disclosure Information; No Product/Research Disclosure Information