Authors: Emmy Zhao, PharmD; Nehal Ahmed, PharmD, BCPS; Daryn Norwood, PharmD, BCPS; Eun Jin Park, PharmD, BCPS, BCIDP; Kelly Hu, PharmD, BCPS
Learning Objective: Describe the impact of pharmacist education on appropriate de-escalation of stress ulcer prophylaxis (SUP).
Background/Objective: Assess appropriateness of SUP discontinuation in the intensive care unit (ICU) prior to and following pharmacist education to providers.
Methods: This single-center study assessed the percentage of appropriate SUP discontinuation pre- and post-pharmacist education in the ICU. Exclusion criteria include patients ≤18 years of age, patients transferred to another hospital on SUP, patients who passed away in the ICU, or patients with an alternative indication for pantoprazole or famotidine. The primary outcome was percentage of patients inappropriately continued on SUP at 48 hours after ICU downgrade. Secondary outcomes included percentage of patients appropriately initiated on SUP per the 2024 SCCM/ASHP guidelines, patients inappropriately discharged on SUP, and patients with documented side effects to SUP
.Results: A higher proportion of patients in the post-intervention group (22/40, 55.0%) compared to the pre-intervention group (22/50, 44.0%) had SUP appropriately discontinued. However, the results were not statistically different (two-sided p = 0.40). Rates of appropriate SUP initiation were similar between pre- and post-intervention groups (76.0% vs 82.5%), as were rates of inappropriate discharge on SUP (12.0% vs 12.5%). There were no documented adverse events thought to be related to SUP medications.
Conclusion: Pharmacist education to providers was numerically associated with increased appropriateness of SUP discontinuation, however, this difference was not statistically significant. This study was limited by its retrospective nature and small sample size. Additional education to decentralized pharmacists to review SUP indications and intervene as appropriate may further elucidate the benefit of pharmacy intervention on appropriate SUP discontinuation.
Self-Assessment Question:Which of the following is not an indication for SUP per the 2024 SCCM/ASHP guidelines?
- Coagulopathy
- Shock
- Chronic liver disease
- Mechanical ventilation
