Implementation of a clinical practice guideline for stress ulcer prophylaxis increases appropriateness and decreases cost of care

Abstract

Objective: To develop, implement and evaluate a practice guideline for stress ulcer prophylaxis. Design: Before-after study. Setting: Ten-bed Intensive Care Unit (ICU) and 4-bed Step-down Unit in a teaching hospital. Patients and participants: Fifty patients admitted during 1 year before and 50 patients admitted 3-6 months after introduction of the guideline. Intervention: Introduction of the practice guideline by dissemination of pocket cards, seminars and 'academic detailing'. Measurements and results: Appropriateness (defined as proportion of days in which the prophylaxis met the criteria in the guideline), incidence of gastrointestinal bleeding and of ventilator-associated pneumonia, length of stay in ICU and in hospital, ventilator days, ICU mortality and medication costs for stress ulcer prophylaxis. After the introduction of the guideline, appropriateness increased from 75.8% to 91.1%, and medication costs decreased from C$2.50/day to C$1.30/day. There were no differences in any clinical outcomes. Predictors of appropriate use or the withholding of prophylaxis were the introduction of the guideline, lack of an indication for prophylaxis and number of days studied. Conclusions: Introduction of this guideline was associated with an in crease in appropriateness of prophylaxis and a decrease in medication costs.