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CRITICAL CARE

Impact of Stress Ulcer Prophylaxis Algorithm Study

Staff Pharmacist, Department of Pharmacy, Royal Victoria Hospital, McGill University Health Center, Montréal, Québec, Canada

Sabrina E Sanzari, BPharm MSc

Staff Pharmacist, Department of Pharmacy, Santa-Cabrini Hospital, Montréal

Reprints: Mr. Coursol, Department of Pharmacy, Royal Victoria Hospital, 687 avenue des Pins O., Montréal, QC H3A 1A1, Canada, fax 514/843-1474, christian.coursol{at}muhc.mcgill.ca

BACKGROUND: In the intensive care unit at Royal Victoria Hospital, we noted that drugs prescribed for stress ulcer prophylaxis were not always indicated or optimal. Accordingly, we implemented an algorithm for stress ulcer prophylaxis to guide the medical team in their decisions. The agents selected for the algorithm were intravenous famotidine and omeprazole suspension or tablets, depending on the available administration route.

OBJECTIVE: To evaluate the impact of a treatment algorithm on the appropriateness of prescriptions for stress ulcer prophylaxis.

METHODS: A quasi-experimental–type evaluative study was conducted based on a pre-/post-intervention design without a concurrent control group. A total of 555 complete admissions met the selection criteria; 303 patients formed the pre-intervention group, and 252 made up the post-intervention group (exposed to the treatment algorithm).

RESULTS: After implementation of the algorithm, the proportion of inappropriate prophylaxis was decreased (95.7% vs 88.2%; p = 0.033). The number of days of inappropriate prophylaxis was also reduced significantly (p = 0.013), as was the cost per patient (p = 0.003) for all admissions. However, no difference was observed when the subgroup of patients who received prophylaxis alone was studied (p = 0.098 and p = 0.918). The presence of bleeding was similar in both groups.

CONCLUSIONS: Introduction by pharmacists of a treatment algorithm for stress ulcer prophylaxis in intensive care units allows a reduction of inappropriate prescriptions and thus a reduction in the cost of drugs. The use of omeprazole suspension seems to be an alternative to intravenous histamine₂-inhibitors; however, a large-scale study is necessary to confirm the efficacy and safety of proton-pump inhibitors administered by an enteral tube.

Key Words: famotidine, H₂-antagonists, omeprazole, proton-pump inhibitors, stress ulcer prophylaxis

Published Online, April 5, 2005. www.theannals.com, DOI 10.1345/aph.1D129