Acid Suppression Therapy in the Hospital Setting: an Evaluation of the Appropriateness of Stress Ulcer Prophylaxis [abstract]

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Abstract from the 2014 ACCP Annual Meeting:

PURPOSE: Prevention of stress ulcer prophylaxis (SUP) through gastric acid suppressive therapy (AST) is common practice in the hospital setting. Despite published guidelines and recommendations describing indications for SUP, AST with proton pump inhibitors (PPIs) and histamine 2 receptor antagonists (H2RAs) is often prescribed inappropriately and is inadvertently continued at discharge. AST has been associated with infectious complications and adverse effects which may complicate disease state management and require need for medical management. We evaluated the utilization of AST and appropriateness of SUP prescribing at a community teaching hospital.

METHODS: Utilizing our electronic medical records, we prospectively evaluated the use of AST in our intensive care units (ICUs) and on our internal medicine units for 3 months. Data collected included AST medication, SUP indication, home AST, and whether AST was continued at discharge.

RESULTS: 445 patients were included in our evaluation and 56% had AST listed as a home medication. SUP accounted for 88% (n=391) of AST prescriptions. PPIs were prescribed more often than H2RAs (61 vs 39%), and IV administration was slightly preferred over oral (56 vs 44%). SUP was inappropriate in 61% of the prescriptions (n=239) and was more likely to occur outside of the ICUs (88% vs 17%). When groups were adjusted for home AST therapy (n=176), inappropriate rates were similar (86 vs 20%). 26% of SUP prescriptions were inappropriately continued at discharge.

CONCLUSION: Inappropriate prescribing of AST for SUP, particularly outside of the ICUs, is common. Of concern is the continuation of AST and the infectious and metabolic risks associated with AST. Our findings suggest a process improvement plan is needed to help the clinician with appropriate SUP prescribing. In order to avoid inadvertent continuation of therapy at discharge, this plan will need to include facilitation of appropriate medication reconciliation at time of transfer and discharge.


Version of record can be found through Wiley.