Some patients in the intensive care unit (ICU) have an increased risk of developing stress ulcers, which are superficial inflammatory lesions of the gastric mucosa caused by abnormally elevated physiological demands on the body. However, research shows there are associated patient health risks with stress ulcer prophylaxis (SUP) – bringing to light the importance of appropriate SUP use and adherence to best practice guidelines.
According to the most current guidelines published by the American Society of Health-System Pharmacists (ASHP), SUPs are recommended for select ICU patients only. Northwest Community Hospital's (NCH) Director of Medical Affairs, Panayota Kleinman, MD, explains that the SUP indication for proton pump inhibitors (PPI) is limited to a subset of ICU patients who meet specified evidence-based criteria.
"PPI use is associated with increased risk of clostridium difficile infections and therefore must be limited to clinically significant conditions," says Dr. Kleinman. "There is no data that supports the initiation of PPI for SUP in the medical/surgical inpatient care units or outpatient setting."
Northwest Community's ICU Pharmacist Tudy Hodgman, PharmD, adds that long term use of PPI may increase a patient's risk for fractures, or serious infections like pneumonia and clostridium difficile. Therefore, once the indication is resolved, the PPI should be discontinued.
Both Dr. Kleinman and Hodgman recommend NCH medical staff members review the ASHP guidelines for SUP (click here for a brief synopsis) and become familiar with the appropriate criteria for its use with select ICU patients. In order to closely monitor the use of PPI for SUP, physicians at NCH need to give the indication at the time the medication is ordered in CPOE. This information is valuable for both the ICU medical team and the clinicians who will care for the patient following a hospital discharge to the next care setting.