Role of Clinical Pharmacist in Implementation of Stress Ulcer Prophylaxis Protocol: A Single Site Retrospective Study

Abstract

Introduction: The incidence of gastrointestinal bleeding is well documented in critical care patients; thus, stress ulcer prophylaxis therapy plays a vital role to prevent it. The guideline recommends the use of histamine antagonists such as ranitidine, famotidine etc. as a first line therapy for stress ulcer due to its cost effectiveness value. However, research show that 28% of intensive care units (ICU) received inappropriate stress ulcer therapy and 81 % were continued on inappropriately upon transfer from ICU. Furthermore, the disparity in the selection of acid-suppressing medication for stress ulcer is very common amongst and within institutions.

Objective: The aim of the study is to standardize stress ulcer therapy according to approved guideline in surgical ICU of a tertiary care hospital of Pakistan with the help of clinical pharmacist.

Methodology: A cross-sectional retrospective study was conducted to evaluate the effectiveness of clinical pharmacist in the implementation of stress ulcer guideline using the data of pharmaceutical intervention and utilization of ranitidine. A one-year retrospective data of pharmaceutical recommendations and drug utilization were collected from October 2017 to September 2018. Descriptive statistics and chi-square analysis   were carried out to analyze the data of the study.

Result: A total of 540 patients records were evaluated for the study. Pre-intervention and post-intervention include 123 and 417 records, respectively. Whereas, pharmaceutical recommendations made by clinical pharmacist were 80 out of 337 (23%). The most common recommendations were conversion from parenteral to oral (40%). Drug utilization of ranitidine improved tremendously (60 vs 3932).

Conclusion: Clinical pharmacist can play a vital role in the implementation and compliance of clinical guideline along with optimization of pharmacotherapy.