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MEDICATION SAFETY

Medication Reconciliation Effect on Prolonged Inpatient Stress Ulcer Prophylaxis

Clinical Pharmacist, Central Michigan Community Hospital, Mt. Pleasant, MI

Karen J McAllen, PharmD

Clinical Specialist, Critical Care, Spectrum Health, Grand Rapids, MI

Martha G Slot, PharmD

Clinical Specialist, Quality, Spectrum Health

Jeffrey F Barletta, PharmD FCCM

Clinical Specialist, Critical Care, Spectrum Health

Reprints: Dr. Barletta, Spectrum Health, Department of Pharmacy, 100 Michigan St. NE (MC01), Grand Rapids, MI 49503, fax 616/391-9598, jeffrey.barletta{at}spectrum-health.org

BACKGROUND: While medication reconciliation (MR) has been shown to reduce medication errors by limiting errors of transcription, omission, and duplicate therapy, its impact on the provision of unnecessary prophylaxis is largely unknown.

OBJECTIVE: To determine the effect of MR on the incidence of prolonged stress ulcer prophylaxis (SUP) across the continuum of care from hospital admission to discharge as well as evaluate clinical conditions associated with prolonged SUP.

METHODS: This retrospective study assessed patients who were admitted to the intensive care unit (ICU) and had SUP initiated. Patients were excluded if they were receiving gastroprotective therapy prior to ICU admission, were being treated for an acute gastrointestinal hemorrhage, or died. The need for SUP was determined using risk factors adapted from evidence-based guidelines developed by the American Society of Health-System Pharmacists. The use of SUP was assessed upon transfer from the ICU to a non-ICU setting and at hospital discharge. Results were compared between pre-MR and post-MR groups.

RESULTS: Data from 114 (pre-MR, n = 53; post-MR, n = 61) medical and surgical ICU patients were evaluated. There was no significant difference in the use of prolonged SUP upon transfer from the ICU to a non-ICU setting in the pre-MR and post-MR groups, respectively (85% [45/53] vs 79% [48/61], p = 0.393). Similarly, there was no significant difference in the use of prolonged SUP upon hospital discharge in the pre-MR and post-MR groups, respectively (14% [6/44] vs 23% [10/43], p = 0.247). There were no clinical conditions for which prolonged SUP use was predominant.

CONCLUSIONS: The strategy of MR alone will not decrease the incidence of prolonged SUP in hospitalized patients. Other techniques should be evaluated to encourage appropriate use of acid-suppressive agents.

Key Words: intensive care unit, prophylaxis, stress ulcer

Published Online, June 24, 2008. www.theannals.com, DOI 10.1345/aph.1L123

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				F. Karapinar-Carkit, S. D Borgsteede, J. Zoer, H. J Smit, A. C. Egberts, and P. M. van den Bemt Effect of Medication Reconciliation With and Without Patient Counseling on the Number of Pharmaceutical Interventions Among Patients Discharged from the Hospital Ann. Pharmacother., June 1, 2009; 43(6): 1001 - 1010. [Abstract] [Full Text] [PDF]