Evaluation of Stress Ulcer Prophylaxis Practices and Inappropriate Continuation Post-ICU Discharge in Medical ICU Patients

Indianapolis, IN

The objective of this study was to determine the percent of patients who were inappropriately continued on acid suppressive therapy when discharged from a medical ICU. This IRB approved, single-center, retrospective, observational study, included adults who were mechanically ventilated for at least 2 consecutive days and receiving SUP from November 1, 2016 to April 30, 2017. Of 294 patients screened, a total of 107 patients met inclusion criteria for the study. Sixty-nine patients (64.5%) were inappropriately continued on acid suppressive therapy upon discharge from the ICU. Of these 69 patients, 50 (72.4%) were continued on an H2RA, 18 (26.1%) on a PPI, and 1 (1.4%) on both a H2RA and PPI. There were 3 patients who had a positive Clostridium difficile PCR test during their hospital stay; one of these patients received an H2RA, 1 patient received a PPI, and 1 patient received both an H2RA and a PPI after ICU discharge. A total of 26 patients (24.3%) were continued on an H2RA or PPI upon discharge from the hospital. The median duration of acid suppressive therapy was 15 days (6-18.5). The majority of patients included were inappropriately continued on acid suppressive therapy upon discharge from the ICU. Additionally, 24.3% of patients were continued on acid suppressive therapy upon discharge from the hospital. These findings support the need for a pharmacist driven discontinuation protocol when acid suppressive therapy is no longer indicated. Future studies are needed to more accurately quantify clinical and economic consequences associated with inappropriate continuation.