Belfield Kristen D, Kuyumjian Arpi G, Teran Rafael, Amadi Mariette, Blatt Melissa, Bicking Keri
1 Yale New Haven Hospital, New Haven, CT, USA.
2 Hackensack University Medical Center, Hackensack, NJ, USA.
Ann Pharmacother. 2017 Jul;51(7):577-583. doi: 10.1177/1060028017698797. Epub 2017 Mar 9.
Stress ulcer prophylaxis (SUP) is inappropriately prescribed in more than 30% of non-intensive care unit (ICU) patients, leading to unnecessary adverse events as well as increases in economic burden.
There was an increasing trend in the prophylactic use of acid suppressive therapy (AST) in non-critically ill patients at our institution, which prompted this initiative aimed at reducing the inappropriate use of AST in non-ICU patients.
This was a retrospective interventional study that consisted of formulation of a guideline, education to the hospitalist service, and intervention by clinical pharmacists. All adult non-ICU patients admitted to the hospitalist service who were newly initiated on AST were considered for inclusion. The primary outcome was a comparison of the proportion of inpatient days with inappropriate AST. Secondary outcomes included a comparison of patients discharged on inappropriate AST and drug acquisition costs, successful pharmacy interventions, hospitalist interventions, incidence of Clostridium difficile infection (CDI) or gastrointestinal (GI) bleeding, and drug costs averted through pharmacy intervention.
There were 61 patients in the historical group and 81 patients in the interventional group. This intervention resulted in a 31% absolute reduction in inappropriate patient days of AST and a 24% absolute reduction in patients discharged on inappropriate AST. There were 23 successful interventions. There were no cases of CDI and 1 GI bleed. This intervention resulted in an 87% reduction in drug acquisition costs per patient.
A collaboration between clinical pharmacists and a hospitalist service can significantly reduce the inappropriate use of AST in non-ICU patients.
超过30%的非重症监护病房（ICU）患者接受了不恰当的应激性溃疡预防治疗（SUP），导致了不必要的不良事件以及经济负担增加。
在我们机构，非危重症患者预防性使用抑酸治疗（AST）的趋势呈上升态势，这促使我们开展此项旨在减少非ICU患者AST不当使用的举措。
这是一项回顾性干预研究，包括制定指南、对住院医师团队进行教育以及临床药师进行干预。所有新开始接受AST治疗的入住住院医师团队服务的成年非ICU患者均纳入研究。主要结局是比较接受不当AST治疗的住院天数比例。次要结局包括比较因不当AST治疗出院的患者、药品采购成本、成功的药学干预、住院医师干预、艰难梭菌感染（CDI）或胃肠道（GI）出血的发生率，以及通过药学干预避免的药品成本。
历史组有61例患者，干预组有81例患者。此项干预使AST不当使用的患者天数绝对减少了31%，因不当AST治疗出院的患者绝对减少了24%。有23次成功干预。无CDI病例，有1例GI出血。此项干预使每位患者的药品采购成本降低了87%。
临床药师与住院医师团队之间的合作可显著减少非ICU患者AST的不当使用。
