Authors
1 Department of Clinical Pharmacy and Pharmacy Practice, Isfahan University of Medical Sciences, Isfahan, Iran
2 Anesthesiology and Critical Care Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
3 Department of Clinical Pharmacy and Pharmacy Practice, Isfahan Pharmaceutical Sciences Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
4 Department of Biostatistics, Isfahan University of Medical Sciences, Isfahan, Iran
5 Department of Gastroenterology, Integrative Functional Gastroenterology Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
Abstract
Objective: Concern about adverse effects of the inconsistent use of stress‑related
mucosal damage prophylaxis in intensive care unit (ICU) is increasing. Hence, this
study was designed to prospectively evaluate the rate of inappropriate stress ulcer
prophylaxis (SUP) administration upon ICU admission, at ICU discharge and determine
the adherence to American Society of Health‑System Pharmacists (ASHP) guideline
during ICU stay.
Methods: In this study, 200 patients were randomly selected from all ICU admissions
during 9 months. Risk factors of stress ulcer were recorded daily during ICU stay and
appropriateness of SUP administration was assessed according to the ASHP criteria.
Findings: Of all 160 (80%) patients who received SUP, 44.4% did not have indication;
and among 95 patients with an indication for SUP administration, 6.3% did not receive
it upon ICU admission. Consequently, 77 (38.5%) of 200 patients received inappropriate
prophylaxis on ICU admission. In addition, 53.5% of patients had appropriate adherence
to ASHP guideline during all days of ICU stay (44% and 2.5% of patients received SUP
more than 120% and <80% of appropriate SUP duration, respectively). Moreover, 81.2%
were continued on inappropriate prophylaxis upon transfer from the ICU.
Conclusion: We concluded that although SUP administration included both
overutilization and underutilization in this ICU, but high prevalence of SUP
overutilization caused unnecessary hospital costs, personal monetary burden, and may
increase adverse drug reactions. Therefore, educating physicians and cooperation of
clinical pharmacists regarding implementing standard protocols could improve patterns
of SUP administration.
Keywords
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