Abstract
Objectives
Stress ulcer prophylaxis initiated for intensive care unit (ICU)-specific indications
is often continued upon transfer or discharge despite lack of indication. This quality
improvement initiative aimed to achieve a 25% reduction from baseline in ICU-initiated
acid suppression therapy prescriptions by May 2021.
Methods
This initiative was conducted in adult ICU patients at Boston Medical Center from
July 2020 through May 2021. A multidisciplinary approach to de-prescribing was utilized,
including the implementation of formalized stress ulcer prophylaxis criteria and an
electronic handoff tool used to identify patients appropriate for assessment of acid
suppression therapy continuation post-ICU stay. The primary outcome measure was the
number of discharge prescriptions for ICU-initiated acid suppression therapy. Secondary
endpoints included incidence of de-prescribing workflow failures, percentage of acid
suppression therapy discharge prescriptions with inappropriate indications, and incidence
of stress ulcer-related gastrointestinal bleeding.
Results
A 55% decrease in ICU-initiated acid suppression therapy discharge prescriptions occurred
after implementing the multidisciplinary workflow. The decrease was sustained for
28 weeks through the completion of the study.
Conclusions
Implementation of a pharmacist-initiated electronic handoff tool along with provider
education and creation of formalized stress ulcer prophylaxis criteria may reduce
the number of ICU-initiated acid suppression therapy prescriptions inadvertently or
inappropriately continued at discharge.
Keywords
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Article info
Publication history
Published online: September 25, 2022
Footnotes
Funding: None.
Conflicts of Interest: None.
Authorship: All authors participated in the preparation of this manuscript.
Identification
Copyright
© 2022 Elsevier Inc. All rights reserved.
