Abstract：
To promote an effective strategy to improve the non-guideline-recommended prescribing (NGRP) of acid suppressive medications for stress ulcer prophylaxis (SUP) in critically ill patients and to evaluate the impact and barriers of a multifaceted intervention on NGRP in critically ill patients.
A retrospective, pre- post-intervention study was performed in the medical-surgical ICU. This study included pre-intervention and post-intervention period. There was no SUP guideline and intervention in the pre-intervention period. In the post-intervention period, the multifaceted intervention included five features: a practice guideline, an education campaign, medication review and recommendations, medication reconciliation, and pharmacist rounding with the ICU team.
A total of 557 patients were studied (305 in the pre-intervention group and 252 in the post-intervention group). Patients who underwent surgery, stayed in ICU more than 7 days, or used corticosteroids experienced significantly higher rate of NGRP in the pre-intervention group. The average percentage of patient days of NGRP was significantly reduced from 44.2% to 23.5% (p < .001) by implementing the multifaceted intervention. The percentage of patients with NGRP decreased from 86.7% to 45.5% in terms of all 5 criteria (indication, dosage, IV to PO, duration, and ICU discharge; p = .003). Per-patient NGRP cost decreased from $45.1 (22.6, 93.0) to $11.3 (11.3, 45.1; p = .004). The main barrier influencing NGRP was the factors of the patient, including the concurrent use of nonsteroidal anti-inflammatory drugs (NSAIDs), the number of comorbidities, and undergoing surgery.
The multifaceted intervention was effective in improving NGRP. Further studies are needed to confirm whether our strategy is cost-effective.
A retrospective, pre- post-intervention study was performed in the medical-surgical ICU. This study included pre-intervention and post-intervention period. There was no SUP guideline and intervention in the pre-intervention period. In the post-intervention period, the multifaceted intervention included five features: a practice guideline, an education campaign, medication review and recommendations, medication reconciliation, and pharmacist rounding with the ICU team.
A total of 557 patients were studied (305 in the pre-intervention group and 252 in the post-intervention group). Patients who underwent surgery, stayed in ICU more than 7 days, or used corticosteroids experienced significantly higher rate of NGRP in the pre-intervention group. The average percentage of patient days of NGRP was significantly reduced from 44.2% to 23.5% (p < .001) by implementing the multifaceted intervention. The percentage of patients with NGRP decreased from 86.7% to 45.5% in terms of all 5 criteria (indication, dosage, IV to PO, duration, and ICU discharge; p = .003). Per-patient NGRP cost decreased from $45.1 (22.6, 93.0) to $11.3 (11.3, 45.1; p = .004). The main barrier influencing NGRP was the factors of the patient, including the concurrent use of nonsteroidal anti-inflammatory drugs (NSAIDs), the number of comorbidities, and undergoing surgery.
The multifaceted intervention was effective in improving NGRP. Further studies are needed to confirm whether our strategy is cost-effective.
摘要：
目的：推广一种有效的策略，以改善危重患者预防应激性溃疡（SUP）的酸抑制性药物的非指南推荐处方（NGRP），并评估对危重患者NGRP的多方面干预的影响和障碍。研究设计与方法：回顾性研究，干预前研究在内科外科ICU中进行。本研究包括干预前和干预后。在干预前期间没有SUP指南和干预。在干预后时期，多方面的干预包括五个特征：实践指南，一场教育运动，药物审查和建议，药物和解，还有ICU团队的药剂师。结果：共研究了557例患者（干预前305例，干预后252例）。接受手术的病人,住在ICU超过7天，或使用皮质类固醇在干预前的NGRP发生率明显较高。通过实施多方面干预措施，NGRP患者平均天数百分比从44.2%显著降低至23.5%(P＜0.001)。就所有5项标准而言，NGRP患者的百分比从86.7％降至45.5％（适应症，剂量,IVtoPO,持续时间,和ICU出院）（P=0.003）。每位患者的NGRP费用从45.1美元（22.6，93.0美元）下降到11.3美元（11.3，45.1美元）（P=0.004）。影响NGRP的主要障碍是患者的因素，包括同时使用非甾体抗炎药（NSAIDs），合并症的数量，并接受手术。结论:多方位干预可有效改善NGRP。需要进一步的研究来确认我们的策略是否具有成本效益。
