Purpose of Study Studies have linked the use of anti-secretory agents to nosocomial complications including Clostridium difficile–induced pseudomembranous colitis and hospital acquired pneumonia. Although there are comprehensive evidence-based guidelines for the initiation of stress ulcer prophylaxis, there are no universally accepted approaches. This has caused nationwide disorganization in current practice, which has led to their overuse. While many studies have shown the pervasiveness of stress ulcer prophylaxis overuse in the hospital setting, none have demonstrated its effect on the community through the improper discharge of patients on these medications.
Methods Used A retrospective review of patient data at a major teaching hospital in New York City was performed. During a 2 month study period, adult non-intensive care patients were randomly selected to determine the incidence of inappropriate initiation of stress ulcer prophylaxis on admission, as compared to the incidence of appropriate use. A follow-up assessment was then completed to determine the incidence of patients that were inappropriately discharged on these medications.
Summary of Results A total of 100 randomly selected patients throughout the inpatient medicine service were analyzed. The results showed a high rate of inappropriate initiation and discharge of patients on anti-secretory agents. The study showed a 50% (n=50) incidence of overall stress ulcer prophylaxis use. Of the patients on stress ulcer prophylaxis, a 76% (n=38) incidence of inappropriate use was found. Of the patients inappropriately on stress ulcer prophylaxis, there was a 53% (n=19) incidence of inappropriate discharge home on these medications.
Conclusions This study highlights the continued inappropriate initiation and discharge of patients on anti-secretory agents, despite mounting evidence and advisories against this practice. The use of an electronic medical record could provide an additional resource to improve quality of care. Electronic prescriptions allow for prompts that ask for a clinical indication during the prescription process. The advent of this technology may yield even more promising improvements in clinical practice, and its implementation is the current focus of a continuing study.
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