Sunday, November 09, 2014

Which patients in the hospital should receive stress ulcer prophylaxis?

Stress ulcer prophylaxis is not a publicly reported core measure or the focus of a government sponsored reimbursement incentive. It is, however, a de facto performance measure, having become embedded in many locally originated care pathways and bundles and consequently driven to excessive use.

Evidence based application of stress ulcer prophylaxis is much more restrictive than common practice. The topic is reviewed concisely in a recent article in Cleveland Clinic Journal of Medicine. From the article:

Based on current evidence and guidelines, routine acid-suppressive therapy to prevent stress ulcers has no benefit in hospitalized patients outside the critical-care setting. Only critically ill patients who meet specific criteria, as described in the guidelines of the American Society of Health System Pharmacists, should receive acid-suppressive therapy...
The American Society of Health System Pharmacists guidelines recommend it in the intensive care unit for patients with any of the following: coagulopathy, prolonged mechanical ventilation (more than 48 hours), GI ulcer or bleeding within the past year, sepsis, a stay longer than 1 week in the intensive care unit, occult GI bleeding for 6 or more days, and steroid therapy with more than 250 mg of hydrocortisone daily.8 Hemodynamically stable patients admitted to general-care floors should not receive stress ulcer prophylaxis...

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