Impact of Stress Ulcer Prophylaxis Algorithm Study

On review of prescribing practices in the intensive careunit (ICU) of the Royal Victoria Hospital, we noted that certain prophylactic therapy was not indicated and that the agent used and the length of treatment did not always seem adequate. Intravenous famotidine is the agent most commonly prescribed to prevent stress ulcers, and oral ran-itidine is occasionally used. One study evaluated the im-pact of an educational program on the number of days of inappropriate prophylaxis, showing a reduction in the aver-age time of inappropriate prophylaxis and treatment cost.1 The design of our study was inspired by that investigation. We conducted a prospective study to evaluate the effect of implementing a treatment algorithm on the number of days of inappropriate stress ulcer prophylaxis and the proportion of prophylactic measures not complying with 4 criteria: choice of agent, dose, administration route, and indication. We also evaluated the effect on treatment costs and gastro-intestinal bleeding. Methods The quasi-experimental pre-/post-intervention research design was se-lected for this study; the study was prospective and was not double-blinded. Included were all patients aged ≥18 years admitted to the ICU between Oc-tober 16 and December 22, 2000, for the pre-intervention phase and be