PURPOSE:Overuse of acid-suppressive treatment among inpatients is a common problem. We believe that one source of this overuse is unnecessary continuation of stress ulcer prophylaxis (SUP) after an intensive care unit admission. A quality improvement project was implemented to decrease unnecessary continuation of SUP following an ICU stay.
METHODS:Charts of all patients admitted to a combined medical-surgical ICU in a community teaching hospital during a one month period were reviewed as baseline. Use of SUP was classified as appropriate (strong indication), acceptable (weaker evidence of benefit) or inappropriate based on a literature review. The project involved implementation of an ICU transfer checklist that included an item recommending discontinuation of SUP at the time of transfer out of the ICU if no longer indicated, and an education component consisting of a 20 minute orientation of the incoming resident team to the checklist. The orientation included a 5 minute didactic component about frequency of inappropriate SUP and its potential complications. The charts of all admissions were again reviewed in the 4th month after implementation of the project.
RESULTS:Use of SUP was very common in both months: 83% and 89%. Proton pump inhibitors were the only agents used in prophylaxis. In the pre-intervention group, 50 of 79 patients (63.25%) being transferred out of the ICU were unnecessarily continued on SUP at the time of transfer. In the post-intervention group, 24 of 76 patients (31.5 %) were transferred out of the unit with inappropriate SUP (p<0.001). None of the patients in either group failed to be treated with appropriate SUP or developed stress-related upper gastrointestinal bleeding during the hospital stay.
CONCLUSION:Unnecessary continuation of SUP is common after an ICU stay. An ICU transfer check list that includes a reminder about discontinuation of SUP if no longer indicated, coupled with a brief didactic intervention, leads to a substantial decrease in unnecessary continuation.
CLINICAL IMPLICATIONS:Unnnecessary continuation of SUP, and its potential complications and expense are avoidable when a reminder system is used.
DISCLOSURE:Aydin Uzunpinar, None.