First Author: Katherine Spetseris, PharmD Co-Author: Caitlin Turnbull, PharmD, BCACP – Dr., Jesse Brown VA Medical Center
Introduction: In recent years, the use of proton pump inhibitors (PPIs) for stress ulcer prophylaxis (SUP) had a rise in inappropriate continuations past the duration the patient was indicated for a PPI per British Medical Journal guidelines. The purpose of this quality improvement project was to assess the current status of PPI discontinuation when SUP was no longer indicated within a Veterans Affairs Medical Center.
Methods: This is a retrospective analysis of patients initiated on intravenous (IV) pantoprazole for SUP during their intensive care unit (ICU) admission between 08/01/2022 and 08/01/2024. Patients admitted to the ICU and initiated on IV pantoprazole for SUP were included. Patients were excluded if they were receiving a PPI prior to ICU admission or an indication for PPI other than SUP during the ICU stay. Baseline demographic data was collected, including age, sex and which criteria for SUP initiation were met. The primary endpoint was the appropriate discontinuation of SUP by hospital discharge. Secondary endpoints evaluated included phase of care in which SUP discontinuation occurred, and safety endpoints such as Clostridium difficile, hospital acquired pneumonia (HAP), and ventilator associated pneumonia (VAP) infections.
Results: Of the 291 participants screened, 30 were evaluated. Ten of the 30 patients (33%) expired before discharge and could not be evaluated for the primary endpoint. Of the 20 remaining, 15 (75%) were appropriately discontinued before hospital discharge. All discontinuations occurred within the ICU. The most common appropriate SUP indication was mechanical ventilation without enteral nutrition (73.3%). HAP and VAP occurred in two of the 30 patients (6.7%). No incidence of Clostridium difficile infection was noted.
Conclusions: These findings showcase that ICU SUP was appropriately discontinued more frequently compared to previous studies and that the patients had a lower risk of safety adverse events. All appropriate discontinuations occurred within the ICU. Opportunities for improvement were identified from this project and additional changes to hospital orders and guidelines are pending.
