Impact of a multifaceted intervention on non-guideline-recommended prescribing of acid suppressive medications for stress ulcer prophylaxis in critically ill patients

Abstract

Objective

To promote an effective strategy to improve the non-guideline-recommended prescribing (NGRP) of acid suppressive medications for stress ulcer prophylaxis (SUP) in critically ill patients and to evaluate the impact and barriers of a multifaceted intervention on NGRP in critically ill patients.

Research design and methods

A retrospective, pre- post-intervention study was performed in the medical-surgical ICU. This study included pre-intervention and post-intervention period. There was no SUP guideline and intervention in the pre-intervention period. In the post-intervention period, the multifaceted intervention included five features: a practice guideline, an education campaign, medication review and recommendations, medication reconciliation, and pharmacist rounding with the ICU team.

Results

A total of 557 patients were studied (305 in the pre-intervention group and 252 in the post-intervention group). Patients who underwent surgery, stayed in ICU more than 7 days, or used corticosteroids experienced significantly higher rate of NGRP in the pre-intervention group. The average percentage of patient days of NGRP was significantly reduced from 44.2% to 23.5% (p < .001) by implementing the multifaceted intervention. The percentage of patients with NGRP decreased from 86.7% to 45.5% in terms of all 5 criteria (indication, dosage, IV to PO, duration, and ICU discharge; p = .003). Per-patient NGRP cost decreased from $45.1 (22.6, 93.0) to $11.3 (11.3, 45.1; p = .004). The main barrier influencing NGRP was the factors of the patient, including the concurrent use of nonsteroidal anti-inflammatory drugs (NSAIDs), the number of comorbidities, and undergoing surgery.

Conclusion

The multifaceted intervention was effective in improving NGRP. Further studies are needed to confirm whether our strategy is cost-effective.

Keywords:

• Acid suppressive medication
• stress ulcer prophylaxis
• intervention
• guideline adherence

Transparency

Declaration of funding

This study was funded by the Beijing Pharmaceutical Association Scientific Research Project (No. 2019-01-05).

Declaration of financial/other relationships

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Author contributions

Conception and design: Furong Han, Chao Zhang, Tong Li, Zhihui Song, Shanshan Xu; Analysis and interpretation of the data: Furong Han, Chao Zhang; Drafting of the manuscript, Revising it for intellectual content, Final approval of the completed manuscript: All authors.

Acknowledgements

Authors would like to thank the advice of Yanjie Zou from St. David’s South Austin Medical Center.

Data availability statement

The datasets from the current research are not publicly available but are available from the corresponding author on request.