Erstad B L, Camamo J M, Miller M J, Webber A M, Fortune J
Department of Pharmacy Practice, University of Arizona, Tucson, USA.
Crit Care Med. 1997 Oct;25(10):1678-84. doi: 10.1097/00003246-199710000-00017.
To determine the appropriateness and medication cost of stress ulcer prophylaxis before and after a targeted educational intervention.
In the preintervention cohort (phase 1), 264 patients were evaluated over 2 months, using stress ulcer prophylaxis guidelines developed by a comprehensive literature search. Targeted educational programs were subsequently used to inform trauma housestaff on appropriate usage of stress ulcer prophylaxis medications with emphasis on using sucralfate. The postintervention cohort (phase 2) involved concurrent evaluation of 279 patients. Length of inappropriate stress ulcer prophylaxis (i.e., did not meet approved guidelines) between phases was compared using a Student's t-test for independent samples (alpha = .05).
A 365-bed university medical center.
Patients admitted to any of the intensive care units and all patients who were placed on histamine-2-antagonists or sucralfate for stress ulcer prophylaxis.
Educational intervention regarding appropriate stress ulcer prophylaxis directed at the trauma service.
Patient demographics in the two phases were similar and there was no difference in the number of patient risk factors for stress-induced bleeding. The mean length of inappropriate stress ulcer prophylaxis was 5.78 +/- 4.36 days in phase 1 and 4.66 +/- 3.10 days in phase 2 (p < .05). Eighty-nine patients in phase 1 received inappropriate stress ulcer prophylaxis for a drug cost of $2,272.00 (mean $25.53 +/- 25.52) compared with 90 patients in phase 2 with a drug cost of $1,417.00 (mean $15.75 +/- 13.06). Three patients in each phase had clinically important bleeding (hemodynamic compromise or transfusion); all were receiving ranitidine. The mean total cost (fixed and variable) of hospitalization was $69,288.00 and $74,709.00 for the three patients who bled in each phase compared with $19,850.00 and $15,812.00 for all patients admitted to the intensive care unit in phases 1 and 2, respectively. The mean length of hospital stay was 30.00 days and 29.33 days for the three patients who bled in each phase compared with 11.54 days and 10.27 days for all patients admitted to the intensive care unit in phases 1 and 2, respectively.
Cost savings are associated with more appropriate stress ulcer prophylaxis. Clinically important bleeding is uncommon but results in prolonged hospital stays and increased costs.
确定针对性教育干预前后应激性溃疡预防措施的合理性及用药成本。
在干预前队列（第1阶段），通过全面文献检索制定应激性溃疡预防指南，对264例患者进行了为期2个月的评估。随后开展针对性教育项目，告知创伤科住院医师应激性溃疡预防药物的合理使用方法，重点强调硫糖铝的使用。干预后队列（第2阶段）对279例患者进行了同期评估。使用独立样本t检验（α = 0.05）比较两个阶段不适当应激性溃疡预防措施的时长（即未符合批准指南）。
一家拥有365张床位的大学医学中心。
入住任何重症监护病房的患者以及所有接受组胺-2拮抗剂或硫糖铝预防应激性溃疡的患者。
针对创伤科开展关于适当应激性溃疡预防的教育干预。
两个阶段的患者人口统计学特征相似，应激性溃疡出血的患者风险因素数量无差异。第1阶段不适当应激性溃疡预防措施的平均时长为5.78±4.36天，第2阶段为4.66±3.10天（p<0.05）。第1阶段89例患者接受了不适当的应激性溃疡预防措施，药物成本为2272.00美元（平均25.53±25.52美元），而第2阶段90例患者的药物成本为1417.00美元（平均15.75±13.06美元）。每个阶段各有3例患者发生具有临床意义的出血（血流动力学不稳定或输血）；所有这些患者均接受雷尼替丁治疗。每个阶段发生出血的3例患者的平均住院总成本（固定成本和可变成本）分别为69288.00美元和7470九.00美元，而第1阶段和第2阶段入住重症监护病房的所有患者的住院总成本分别为19850.00美元和15812.00美元。每个阶段发生出血的3例患者的平均住院时长分别为30.00天和29.33天，而第1阶段和第2阶段入住重症监护病房的所有患者的平均住院时长分别为11.54天和10.27天。
更合理的应激性溃疡预防措施可节省成本。具有临床意义的出血并不常见，但会导致住院时间延长和成本增加。
