PURPOSE: Guidelines for the use stress ulcer prophylaxis in critically ill patients have been well documented, yet inappropriate use continues. The purpose of our study was to evaluate factors that contribute to the overuse of stress ulcer prophylaxis.
METHODS: A retrospective review of all intensive care unit (ICU) patients admitted over a two month time period from a single, tertiary hospital was performed. Appropriate and inappropriate use of stress ulcer prophylaxis based on evidence based institutional guidelines were documented and then compared based on admitting service specialty and level of training of person writing the order.
RESULTS: The study included 103 ICU patients (55.3% male). Average length of hospital, ICU, and ventilator days were 6.3 days, 2.9 days, and 1.3 days, respectively. Stress ulcer prophylaxis was inappropriately used in 40 patients (38.8%) and inappropriately withheld in 5 patients (4.9%) for an overall noncompliance rate of (43.7%). The average amount of time for the inappropriate use of stress ulcer prophylaxis was 4.1 days. Inappropriate use of stress ulcer prophylaxis was significantly related to specialty of admitting service (surgery 25.5% vs. medicine 50.0%, p=0.011) and level of training of person writing the order (attending 36.8% vs. resident 61.1%, p=0.037).
CONCLUSION: Noncompliance with institutional guidelines for stress ulcer prophylaxis remains a problem in ICU patients. Factors that increase the likelihood of the inappropriate use of stress ulcer prophylaxis include being admitted to a medicine service and the order being written by a resident physician.
CLINICAL IMPLICATIONS: Ongoing education remains the key to improve compliance amongst all physicians. Inappropriate use of pharmacologic agents has significant cost implications.
DISCLOSURE: Ronald Sing, No Financial Disclosure Information; No Product/Research Disclosure Information