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CRITICAL CARE

Inappropriate Continuation of Stress Ulcer Prophylactic Therapy After Discharge

at the time of the study, Pharmacy Critical Care Specialty Resident, University of Wisconsin Hospital and Clinics, Madison, WI; now, Clinical Pharmacist, Critical Care Medicine, Clinical Team Leader, Department of Pharmacy, Intermountain Healthcare, LDS Hospital, Salt Lake City, UT

Lizbeth A Hansen, PharmD

at the time of the study, PharmD Student, School of Pharmacy, University of Wisconsin; now, Pharmacy Practice Resident, Medical University of South Carolina, Charleston, SC

Jeffrey T Fish, PharmD

Senior Clinical Pharmacist, University of Wisconsin Hospital and Clinics

Reprints: Dr. Fish, Pharmacy Services F6/133-1530, University of Wisconsin Hospital and Clinics, 600 Highland Ave., Madison, WI 53792, fax 608/263-9424, jfish{at}uwhealth.org

BACKGROUND: Medications for stress ulcer prophylaxis are appropriately started in critically ill patients with risks for developing stress ulcers. It is unknown whether these drugs are discontinued once the risk factors are removed.

OBJECTIVE: To assess the duration of stress ulcer prophylactic therapy in critically ill patients.

METHODS: A retrospective chart review was conducted at a multidisciplinary, 24 bed medical/surgical intensive care unit (ICU) of a university-affiliated tertiary referral medical center. Three hundred ninety-four patients fulfilled eligibility criteria during the study period of July 1, 2005, through September 30, 2005. Patients were considered to be appropriately discharged from the hospital on gastric acid suppressants if they met any of the following criteria: continued mechanical ventilation, gastroesophageal reflux disease, peptic ulcer disease, history of gastrointestinal ulceration or bleeding within the past year, prescribed medications used for stress ulcer prophylaxis prior to admission, gastrointestinal bleed during hospitalization, or prescriber indication of reason to continue therapy.

RESULTS: Three hundred fifty-seven patients received stress ulcer prophylaxis during their ICU stay. Of these, 80% continued on gastric acid suppressants on transfer from the ICU, with 60% of the therapy being inappropriate. The percentage of critically ill patients discharged from the hospital with inappropriate prescription of gastric acid suppressants was 24.4%. Based on the average wholesale cost, the total cost for unnecessary gastric acid suppressant therapy within the follow-up period was $13,973.

CONCLUSIONS: Gastric acid suppressant medications initially prescribed for stress ulcer prophylaxis are frequently prescribed inappropriately on discharge for patients who were initially admitted to the medical/surgical ICU.

Key Words: critical care, duodenal ulcer, stress ulcer

Published Online, September 11, 2007. www.theannals.com, DOI 10.1345/aph.1K227

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