Ensuring guideline adherence and cost savings in stress ulcer prophylaxis practices in the intensive care unit: a pre-post education study.

Abstract

Objective: This study aims to enhance adherence to the guideline through an educational program focused on reducing inappropriate use of stress ulcer prophylaxis (SUP) and cost savings in the intensive care unit (ICU).

Method: This study was designed as a nonrandomized, controlled, prospective study created according to the pre-education (PreEd) and post-education (PostEd) evaluation model and conducted between January and July 2024. The appropriateness of SUP uses for the indication was evaluated according to the Sociedade Portuguesa de Cuidados (SPC) SUP guideline. Adherence rates to the SPC SUP guideline and the costs associated with nonadherence were evaluated.

Results: 495 patients were included in the study, 244 in PreEd and 251 in PostEd. 58.2% of the patients were male, and the hospitalization was mainly for medical reasons (59.6%). The mean ± SD rate of patients with appropriate SUP indication was 38.3 ± 41.6% in PreEd and 47.8 ± 42.8% in PostEd (p = 0.005). The total costs of inappropriate indication and proton pump inhibitor use in PreEd and PostEd were 272 dollars and 246 dollars, respectively (p = 0.007). Accordingly, when inappropriate SUP agent use was calculated per patient in both periods, the total cost saving was 34 dollars.

Conclusion: Inappropriate SUP use is common in the ICU. Adequate adherence to guidelines and proactive involvement of clinical pharmacists may reduce inappropriate SUP use and associated costs.