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Abstract

Introduction: To evaluate the implementation of a stress ulcer prophylaxis guideline (SUPG) in a Nueroscience ICU (NSICU). Hypothesis: SUPG will increase appropriate use of SUP pharmacotherapy, decrease adverse effects (GI Bleeding, pneumonia, Clostridium Difficile (C. Diff)) and decrease pharmacy costs. Methods: Single center, retrospective, cohort study conducted at an academic level-1 trauma center. Patients admitted to the NSICU in 2009 and 2010 with a duration of stay greater than 72 hours were included. Patients were identified through use of NSICU admission records and the pharmacy billing database. Additionally, demographic information was captured through use of the University Health system Consortium database. Patients were divided into two groups pre-SUPG (PRE) implementation and post SUGP (POST) Results: 300 patients (PRE 150, POST 150) were included. SUP use/100 NSICU days differed between PRE and POST (96 vs. 89 days; p=0.010).There was no difference in the total number of patients who received SUP between PRE and POST (141(93%) vs. 143(95%); p=0.667). No difference was observed in overall proton pump inhibitor (PPI) use between PRE and POST groups (45(32%) vs. 57(40%); p=0.203) or in the number of PPI use/100 NSICU days (69 vs. 77 days; p=0.784). There was no difference between PRE and POST incidence of GI bleed (1(0.7%) vs. 2(1.4%); p=0.981), pneumonia (29(19.6%) vs. 19 (13.2%); p=0.188) or in C. diff occurrence (8(5.4%) vs. 2(1.4%); p=0.113). There was no difference between PRE and POST in overall cost of SUP ($1,400 vs. $1,075; p=1.00), PPI use ($995 vs. $800; p=1.00) or histamine receptor antagonist use ($405 vs. $265; p=1.00). Conclusions: The implementation of this stress ulcer prophylaxis guideline reduced the total use of stress ulcer prophylaxis/100 days with no change in the rate of GI bleed. Therefore, a stress ulcer prophylaxis guideline is useful to reduce potentially unnecessary medication use. Additionally, the results showed a trend toward reductions in pneumonia and C. diff infection. While there was no significant reduction in cost, cost savings were evident.