| TITLE |
| Stress Ulcer Prophylaxis in Critical Care |
| BACKGROUND |
| Stress ulcer prophylaxis (SUP) is routine practice when caring for critically ill patients as these ulcers impose significant morbidity and mortality1,2,3. Two major risk factors for GI bleeding have been identified; mechanical ventilation >48 hours and coagulopathy1. Other risk factors include shock, trauma, burns, renal failure, liver failure and a history of peptic ulcer disease4,5 . In recent years concerns have been increasing regarding the risk versus benefit of SUP. Full enteral nutrition tolerated by critically ill patients is adequate SUP in low-risk patients6,7,8 . To minimise adverse health outcomes and costs SUP should be discontinued when patients are no longer considered high risk for GI bleeding or on discharge from critical care2,9. Despite the majority of patients being considered low risk for gastrointestinal ulcers on discharge from critical care, several studies have demonstrated a high rate of ongoing SUP among patients on discharge10,11. The implementation of prescribing guidelines significantly improves SUP practice 11,12. |
| METHODS |
| Service Evaluation as part of MSc in Advanced Clinical Practice Question: Is stress ulcer prophylaxis discontinued prior to discharge from an adult critical care unit? Aims • To identify if SUP is discontinued prior to discharge from an adult critical care unit • If SUP was continued on discharge, were risk factors present requiring its ongoing use? Method • Include: All patients discharged from a critical care unit • Data collection tool created to assess risk factors • Data collected over a 3-month period • 372 patients screened • 79 patients eligible for inclusion |
| RESULTS |
| Results • 63% of patients were discharged from critical care with SUP prescribed • 22% of those had risk factors for its ongoing use |
| DISCUSSION |
| • Identified need for a prescribing guideline in practice to standardise and support clinicians in decision making relating to SUP. Quality Improvement Project undertaken as part of MSc in Advanced Clinical Practice • Review of evidence undertaken • Prescribing guideline created • Consultation with clinical supervisor • Approval at department clinical governance meeting and from pharmacy safer medicines practice group • Implemented into practice • Plan to reaudit 6 months post implementation  Figure 1: Stress ulcer prophylaxis guideline implemented into practice |
| ACKNOWLEDGEMENTS |
| REFERENCES |
| Cook DJ, Fuller HD, Guyatt GH, Marshall JC, Leasa D, Hall R, et al. Risk Factors for Gastrointestinal Bleeding in Critically Ill Patients. New England Journal of Medicine. 1994 Feb 10;330(6):377–81.Saeed M, Bass S, Chaisson NF. Which ICU patients need stress ulcer prophylaxis? Cleveland Clinic Journal of Medicine. 2022 Jul;89(7):363–7.Weinhouse G. Stress ulcers in the intensive care unit: Diagnosis, management, and prevention [Internet]. Uptodate.com. Wolters Kluwer; 2022 Krag M, Marker S, Perner A, Wetterslev J, Wise MP, Schefold JC, et al. Pantoprazole in Patients at Risk for Gastrointestinal Bleeding in the ICU. The New England Journal of Medicine [Internet]. 2018.Evans L, Rhodes A, Alhazzani W, Antonelli M, Coopersmith CM, French C, et al. Surviving Sepsis Campaign: International guidelines for management of sepsis and septic shock 2021. Critical Care Medicine [Internet]. 2021.El-Kersh K, Jalil B, McClave SA, Cavallazzi R, Guardiola J, Guilkey K, et al. Enteral nutrition as stress ulcer prophylaxis in critically ill patients: A randomized controlled exploratory study. Journal of Critical Care. 2018 Feb;43:108–13.Barletta JF. Prophylactic acid suppression and enteral nutrition. Current Opinion in Clinical Nutrition and Metabolic Care. 2022 Dec 30;26(2):174–8.Huang HB, Jiang W, Wang CY, Qin HY, Du B. Stress ulcer prophylaxis in intensive care unit patients receiving enteral nutrition: a systematic review and meta-analysis. Critical Care. 2018 Jan 28;22(1).Eisa N, Bazerbachi F, Alraiyes AH, Alraies MC. Do all hospitalized patients need stress ulcer prophylaxis? Cleveland Clinic Journal of Medicine [Internet]. 2014.Farley KJ, Barned KL, Crozier TM. Inappropriate continuation of stress ulcer prophylaxis beyond the intensive care setting. Critical Care and Resuscitation. 2013 Jun 1;15(2):147–51.Jones CA, Betthauser KD, Lizza BD, Juang PA, Micek ST, Kollef MH. Impact of Stress Ulcer Prophylaxis Discontinuation Guidance in Mechanically Ventilated, Critically Ill Patients: A Pre-Post Cohort Study. Hospital Pharmacy. 2021 Dec 7;57(4):510–7.Deshpande S, Dessoky MA, Brock P. Algorithm based management improves compliance with Stress Ulcer Prophylaxis in ICU. Journal of Anaesthesia Practice [Internet]. 2017. |
