Evaluation of Stress Ulcer Prophylaxis Guideline in the Intensive Care Units of a Teaching Hospital: A Cross Sectional Study

: A Retrospective survey

  • Afsaneh Vazin Shiraz University of Medical Sciences
  • ُSeyed Ruhollah Mousavinasab Shiraz University of Medical Sciences
  • Golnar Sabetian Shiraz University of Medical Sciences

Abstract

Evaluation of stress ulcer prophylaxis guideline in the intensive care units of a Namazi Hospital, Shiraz, Iran: A Retrospective survey

 

Afsaneh Vazin1,Seyed Ruhollah Mousavinasab1*, Golnar Sabetian2*

 

1 Department of Clinical Pharmacy, Faculty of Pharmacy, Shiraz University of Medical Sciences, Shiraz, Iran.

2 Department of Anesthesiology and Critical Care Research Center, Shiraz University of Medical Sciences, Shiraz, Iran.

 

Abstract

Background: Ureasonable medicine use is widespread in hospitals around the world and has raised concerns especially in developing countries due to financial constraints in the field of health care. One of the complications of Critical ill Patients Admitted to intensive care units (ICU) are stress-related mucosal damage. Stress ulcer prophylaxis should be administered to all critically ill patients at least one major risk factor and two or more minor criteria are present. Various medications are used to prevent ulcerative prophylaxis in critically ill patients admitted to ICU, Including: Antacids، sucralfate, Histamine-2-receptor antagonists (H2RAs) and proton pump inhibitors (PPIs). When economic and financial considerations are taken into account, many clinicians prefer intravenous H2 blockers (usually famotidine) administration. In situations where cost is not an issue, an intravenous PPI is an appropriate choice

Methods: This Survey was designed to evaluate appropriate Stress Ulcer Prophylaxis (SUP) practice during 6 months from October 2013 to December 2013 in the intensive care units of a Namazi Hospital. To assess the appropriate administration of SUP, was performed based on ASHP protocol (Table 1).

Results: Among 94 patients included in this study, more than half, 48 (51%), were female, and an average stayed in the hospital for more than 14 days. Fewer than half, 46 (49%), were male and an average stayed in the hospital for more than 10 days. The mean age of study subjects was 51.5 ± 21.12 years (54±24 for female and 49.23±18.9 for men). The most major risk factor to stress ulcer is Mechanical Ventilation> 48 h (24.1%), followed by Coagulopathy (10.9%). Among the minor risk factors, the most minor risk factor to stress ulcer is ICU admission lasting >1 week, followed by Glucocorticoid therapy (10.3%). Most prescribed medication for stress ulcer prophylaxis (SUP) was IV (intravenous) Pantoprazole (44.7%) and lowest prescribed medication for stress ulcer prophylaxis (SUP) was omeprazole po (means the medication is taken by mouth) (7.4%).90 (95.7%) of the study participants were given SUP, among which 66 (70.2%) were given with indication of treatment according ASHP protocol and 28 (34%) given without indication. In total, 4 (4.3%) of the study subjects were not given SUP.

Conclusion: The results of this study showed that the most major risk factor to stress ulcer in our study was a Mechanical Ventilation > 48 h (24.1%), the most minor risk factor to stress ulcer in our study was a ICU admission lasting >1 week (23.6%).92% of patients admitted were not eligible for SUP and in 58% of cases, SUP administration was incorrect.

Keywords:: Stress Ulcer Prophylaxis, Major risk factor, critically ill patients, Retrospective survey

 

 

*Corresponding Author, Department of Clinical Pharmacy, Faculty of Pharmacy, Shiraz University of Medical Sciences. Shiraz, Iran. Telephone Number: +98 71 3242 4126.Fax Number: +98 71 3242 4127. Postal Code: 7146864685. Email:mousavinasab@sums.ac.ir.

Golnar Sabetian MD; Trauma Research Center, Rajaee Hospital, Chamran Blvd., Shiraz, Iran Tel: +98 71 36360697 Fax: +98 71 36248980. Postal Code: 7193613311 Email:gsabetian@yahoo.com

 

Author Biographies

Afsaneh Vazin, Shiraz University of Medical Sciences

Department of Clinical Pharmacy, Faculty of Pharmacy, Shiraz University of Medical Sciences, Shiraz, Iran.

Golnar Sabetian, Shiraz University of Medical Sciences

Department of Anesthesiology and Critical Care Research Center, Shiraz University of Medical Sciences, Shiraz, Iran

References

REFERENCES

1. Holloway K, Green T. Drug and therapeutics committees: a practical guide: World Health Organization; 2003. Available at: http://apps.who.int/medicinedocs/en/d/Js4882e/. Accessed 27 March 2017.
2. Maiti R, Bhatia V, Padhy BM, Hota D. Essential Medicines: An Indian Perspective. Indian J Community Med. 2015; 40:223–32. https://doi.org/10.4103/0970-0218.164382.
3. Cook DJ, Griffith LE, Walter SD, et al. The attributable mortality and length of intensive care unit stay of clinically important gastrointestinal bleeding in critically ill patients. Crit Care 2001; 5:368–375.
4. Plummer MP, Blaser AR, Deane AM. Stress ulceration: prevalence, pathology and association with adverse outcomes. Crit Care 2014; 18:213.
5. www.Uptodate.com.
6. Cook D, Guyatt G. Prophylaxis against Upper Gastrointestinal Bleeding in Hospitalized Patients. N ENG l j med 378;26 nejm.org June 28, 2018
7. J.M. Avenda˜no-Reyes_, H. Jaramillo-Ramírez. Prophylaxis for stress ulcer bleeding in the intensive care unit Revista de Gastroenterología de México. 2014; 79(1):50-55.
8. Mohebbi L, Hesch K. Stress ulcer prophylaxis in the intensive care unit. Proc (Bayl Univ Med Cent) 2009; 22(4):373–376.
9. ASHP Therapeutic guidelines on stress ulcer prophylaxis. ASHP commission on therapeutics and approved by the ASHP board of directors on November 14, 1998. Am J Health Syst Pharm. 1999; 56:347–79 [PubMed: 10690219].
10. Jeffrey F. Barletta, Jeffrey J. Bruno, Mitchell S. Buckley, Deborah J. Cook. Concise Definitive Review: Stress Ulcer Prophylaxis. Critical Care Medicine. XXX 2016 • Volume XX • Number XXX.
11. Krag M, Perner A, Wetterslev J, et al. Prevalence and outcome of gastrointestinal bleeding and use of acid suppressants in acutely ill adult intensive care patients. Intensive Care Med 2015; 41:833–845.
12. Frandah W, Colmer-Hamood J, Nugent K, et al. Patterns of use of prophylaxis for stress-related mucosal disease in patients admitted to the intensive care unit. J Intensive Care Med 2013; 29:96–103.
13. Cook DJ, Fuller HD, Guyatt GH, et al. Risk factors for gastrointestinal bleeding in critically ill patients. Canadian Critical Care Trials Group. N Engl J Med. 1994; 330(6):377-81. Available at: http://content.nejm.org/cgi/ content/full/330/6/377. Accessed January 18, 2010.
14. Farrell CP, Mercogliano G, Kuntz CL. Overuse of stress ulcer prophylaxis in the critical care setting and beyond. J Crit Care. 2010 Jun; 25(2):214-20.
15. Herzig SJ, Howell MD, Ngo LH, Marcantonio ER. Acid-suppressive medication use and the risk for hospital-acquired pneumonia. JAMA. 2009 May 27; 301(20):2120-8.
16. Schepp W: Stress ulcer prophylaxis: still a valid option in the 1990’s? Digestion 1993; 54:189–199.
17. Issa IA, Soubra O, Nakkash H, Soubra L. Variables associated with stress ulcer prophylaxis misuse: A retrospective analysis. Dig Dis Sci. 2012; 57:2633–41.
18. Khalili H, Dashti-Khavidaki S, Hossein Talasaz AH, Tabeefar H, Hendoiee N. Descriptive analysis of a clinical pharmacy intervention to improve the appropriate use of stress ulcer prophylaxis in a hospital infectious disease ward. J Manag Care Pharm. 2010; 16:114–21
19. Foroughinia F, Madhooshi M. Attachment to stress ulcer prophylaxis guideline in the neurology wards of two teaching and non-teaching hospitals: A retrospective survey in Iran. J Res Pharm Pract. 2016 Apr-Jun; 5(2): 138–141.
Published
2020-06-26
How to Cite
1.
Vazin A, MousavinasabُR, Sabetian G. Evaluation of Stress Ulcer Prophylaxis Guideline in the Intensive Care Units of a Teaching Hospital: A Cross Sectional Study. J Pharm Care. 8(2):65-69.
Section
Original Article(s)