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A6831 - Inappropriate Continuation of Stress Ulcer Prophylaxis Following ICU Discharge
Author Block: A. Daggan1, J. Mercado2, A. Singh3, J. Caines3, E. Ola1, A. Renson1, P. Bhatt1, P. Ayoung-Chee4; 1Division of Pulmonary, Allergy, and Critical Care, NYU Langone Brooklyn Medical Center, Brooklyn, NY, United States, 2Pulmonary and Critical Care, NYU Langone Brooklyn Medical Center, New York, NY, United States, 3Division of Internal Medicine, NYU Langone Brooklyn Medical Center, Brooklyn, NY, United States, 4Division of Surgery and Critical Care, NYU Langone Brooklyn Medical Center, Brooklyn, NY, United States.
Rationale Proton pump inhibitors (PPI) are commonly used in the intensive care unit (ICU) for stress ulcer prophylaxis (SUP) and are oftentimes inappropriately continued at the time of de-escalation in level of care and even hospital discharge. While associated with reduced risk of gastrointestinal hemorrhage, PPI use is also associated with significant adverse side effects, including Clostridium difficile colitis, fractures, hypomagnesemia, pneumonia, renal impairment and potential adverse cardiovascular events in the setting of concomitant clopidogrel use. The use of checklists in the ICU to affect clinically meaningful outcomes have shown mixed results. However, none of these checklists have specifically looked at regulating the use of stress ulcer prophylaxis. Methods Data were extracted from the EMR from 09/01/2016-2/28/2017, based on inclusion and exclusion criteria and analyzed to determine the prevalence of inappropriate continuation of SUP at MICU and SICU and hospital discharge. Patient data, including age, sex, ICU length of stay, hospital length of stay, C. diff infection, GI bleed, pneumonia, duration of mechanical ventilation, duration of PPI, and mortality, were extracted from the EMR. Categorical and dichotomous variables were summarized using frequencies and percentages, and continuous variables were summarized using mean±SD or median [IQR] as appropriate. Association between inappropriate continuation of SUP and C. difficile was assessed. Data analysis was done using R statistical software. Results:The main indication for stress ulcer prophylaxis in our patient cohort was initiation of mechanical ventilation. The main pharmacologic agent used was a proton pump inhibitor. At ICU discharge, 53% of patients were inappropriately continued on therapy. At hospital discharge, 40% of patients were inappropriately continued on proton pump inhibitors. There was no associated increase in C. diff infections or rate of ventilator-associated pneumonia. Conclusions:In our patient cohort, the majority of our patients were discharged from the ICU on inappropriate therapy. At hospital discharge, 40% of patients were continued on inappropriate therapy. However, this inappropriate prescribing pattern was not associated with any clinically meaningful events.