Introduction: Stress ulcers are superficial lesions that commonly develop in the fundus and body of the stomach, often as a result of physiological stress associated with hospitalization. Patients in the intensive care unit (ICU) are particularly susceptible to these ulcers, prompting routine initiation of stress ulcer prophylaxis (SUP). However, SUP is often not discontinued once the patient’s risk factors subside. This study aimed to reduce the inappropriate continuation of SUP during inpatient care and at discharge at Piedmont Athens Regional by implementing a pharmacist-led guidance document to support appropriate discontinuation practices. Methods: This single-center, pre-post interventional study evaluated patients admitted to the medical or cardiac ICU who were initiated on SUP. A pharmacist-driven guidance document outlining criteria for SUP discontinuation was implemented. The pre-intervention group consisted of 50 randomly selected patients admitted between November 2023 and January 2024, while the post-intervention group included 50 patients admitted between November 2024 and January 2025. Eligible patients were aged ≥ 18 years, admitted to the medical or cardiac ICU for more than 24 hours, and receiving either a proton pump inhibitor (PPI) or a histamine-2-receptor antagonist (H2RA). The primary outcome was the number of days patients remained on inappropriate SUP. The secondary outcomes were the number of patients discharged on inappropriate SUP at both ICU and hospital discharge. Continuous and categorical variables were analyzed using the Mann-Whitney U test and Chi-Square test, respectively. Statistical significance was assessed with a significance level of 0.05. Results: The post-intervention group had fewer total days on SUP (4.1 vs 5.7 days, p = 0.03) and fewer days of inappropriate SUP use (0.2 vs 1.1 days, p = 0.04) compared to the pre-intervention group. ICU discharge on SUP decreased (54% vs 76%, p = 0.021), while hospital discharge on SUP also declined (14% vs 20%), though not significantly (p = 0.424). Conclusions: This study highlights the positive impact of pharmacist-led interventions in reducing overall and inappropriate SUP use. Findings support the benefit of a standardized approach to regularly reassess SUP appropriateness.
Wallace et al. (Sun,) studied this question.