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

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: [phone].Fax Number: [phone]. Postal Code: 7146864685. Email:[email protected]. Golnar Sabetian MD; Trauma Research Center, Rajaee Hospital, Chamran Blvd., Shiraz, Iran Tel: [phone] Fax: [phone]. Postal Code: 7193613311 Email:[email protected]