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BRIEF REPORT: Reducing Inappropriate Usage of Stress Ulcer Prophylaxis Among Internal Medicine Residents
Author(s) -
Liberman Joshua D.,
Whelan Chad T.
Publication year - 2006
Publication title -
journal of general internal medicine
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.746
H-Index - 180
eISSN - 1525-1497
pISSN - 0884-8734
DOI - 10.1111/j.1525-1497.2006.00435.x
Subject(s) - medicine , stress ulcer , intensive care medicine , medline , alternative medicine , family medicine , pathology , political science , law
BACKGROUND: Many inpatients receive stress ulcer prophylaxis (SUP) inappropriately. This indiscriminate usage increases costs and avoidable side‐effects. Practice‐based learning and improvement (PBLI) methodology may improve compliance with published guidelines. OBJECTIVE: To investigate the response of internal medicine residents to an educational intervention regarding SUP. DESIGN: A prospective, pre and postintervention cohort study using an educational intervention based on PBLI. PATIENTS: Three groups of consecutively admitted patients (1 group preintervention and 2 groups postintervention) on the medicine ward at a University Hospital. MAIN OUTCOME MEASURE: Rates of inappropriate SUP prescription and discharge with an inappropriate prescription. RESULTS: One month after the intervention, inappropriate prophylaxis was significantly decreased (59% pre, 29% postintervention, P <.002). The rate of discharge with an inappropriate prescription also decreased, but was not significant (25% pre, 14% postintervention, P =.14). In the 6‐month postintervention cohort, inappropriate SUP remained lower (59% pre, 33% postintervention, P <.007). The rate of discharge with an inappropriate prescription was also significantly lower (25% pre, 7% postintervention, P <.009). CONCLUSION: Practice‐based learning and improvement can improve compliance with published guidelines, and change practice patterns. After the intervention, both inappropriate prophylaxis and inappropriate prescriptions upon discharge were reduced. Importantly, the intervention was sustained, transmitted across academic years to a new class of interns who had not directly experienced the intervention.