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Stress ulcer prophylaxis in non‐critically ill patients: a prospective evaluation of current practice in a general surgery department
Author(s) -
Bez Coraline,
Perrottet Nancy,
Zingg Tobias,
Leung Ki EnLing,
Demartines Nicolas,
Pannatier André
Publication year - 2013
Publication title -
journal of evaluation in clinical practice
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.737
H-Index - 73
eISSN - 1365-2753
pISSN - 1356-1294
DOI - 10.1111/j.1365-2753.2012.01838.x
Subject(s) - medicine , medical prescription , esomeprazole , stress ulcer , prospective cohort study , emergency medicine , intensive care unit , intensive care medicine , pharmacology
Rationale, aims and objectives There is little evidence regarding the benefit of stress ulcer prophylaxis (SUP) outside a critical care setting. Overprescription of SUP is not devoid of risks. This prospective study aimed to evaluate the use of proton pump inhibitors (PPIs) for SUP in a general surgery department. Method Data collection was performed prospectively during an 8‐week period on patients hospitalized in a general surgery department (58 beds) by pharmacists. Patients with a PPI prescription for the treatment of ulcers, gastro‐oesophageal reflux disease, oesophagitis or epigastric pain were excluded. Patients admitted twice during the study period were not reincluded. The American Society of Health‐System Pharmacists guidelines on SUP were used to assess the appropriateness of de novo PPI prescriptions. Results Among 255 patients in the study, 138 (54%) received a prophylaxis with PPI, of which 86 (62%) were de novo PPI prescriptions. A total of 129 patients (94%) received esomeprazole (according to the hospital drug policy). The most frequent dosage was at 40 mg once daily. Use of PPI for SUP was evaluated in 67 patients. A total of 53 patients (79%) had no risk factors for SUP. Twelve and two patients had one or two risk factors, respectively. At discharge, PPI prophylaxis was continued in 33% of patients with a de novo PPI prescription. Conclusions This study highlights the overuse of PPIs in non‐intensive care unit patients and the inappropriate continuation of PPI prescriptions at discharge. Treatment recommendations for SUP are needed to restrict PPI use for justified indications.