1242 Targeting Inappropriate Stress Ulcer Prophylaxis: A Multidisciplinary Approach

Abstract

INTRODUCTION: Use of stress ulcer prophylaxis (SUP), administration of acid suppressive therapies (AST) to prevent nosocomial gastrointestinal bleeding, is rampant outside of intensive care units despite a lack of data supporting its efficacy. Inappropriate use rates as high as 90% have been reported nationally. Following this, many times AST is inappropriately continued at discharge as well. Potential side effects include vitamin B12 deficiency, osteoporosis, Clostridium difficile infection, pneumonia and CKD. A multidisciplinary educational approach has been used to improve prescribing patterns in other disease states. METHODS: We aimed to decrease inappropriate stress ulcer prophylaxis using a multidisciplinary academic detailing team on an inpatient internal medicine teaching service (IIMTS). Using the quality improvement model plan-do-study-act (PDSA), we retrospectively collected baseline data on inappropriate SUP use on IIMTS over one month. We then implemented PDSA 1: academic detailing, whereby a multidisciplinary team (clinical pharmacist plus internist), gave teaching sessions on appropriate SUP indications to IM residents. With PDSA 2, we introduced a hard stop into IIMTS note templates. We collected prospective post-intervention data for one month after each intervention. RESULTS: Pre-intervention, 95 patients received AST, of which 68 (71%) were receiving AST prior to admission and 27 were prescribed AST upon admission. Overall rates of inpatient initiation of SUP decreased from 25.4% to 16.4% and then 5.4% from the pre-intervention phase to PDSA 1 and PDSA 2 respectively. Rates of inappropriate SUP use also decreased from 8.4% to 7.1% and then 4% respectively. CONCLUSION: Academic detailing as a means to change clinician practices through evidence-based medicine has been shown to have a risk difference of up to 16% in the literature. Furthermore, the addition of a hard stop has been shown to effectively make these changes more permanent. These strategies were successfully used in our inpatient setting to decrease inappropriate AST use, subsequently translating to a reduction in long term complications and cost accrual.