ABSTRACT
OBJECTIVE: To determine how frequently stress ulcer prophylaxis (SUP) medications prescribed in the intensive care unit are inappropriately continued on the ward and on hospital discharge. DESIGN: Retrospective cohort study; chart review. SETTING: Two Australian ICUs: one tertiary centre and one metropolitan centre. PARTICIPANTS: We included 387 adult, non-pregnant patients who were admitted to the ICU between 1 February 2011 and 31 March 2011 and who survived to hospital discharge. MAIN OUTCOME MEASURES: Rate of unnecessary continuation of ICU-prescribed SUP medications on the ward and on discharge from hospital. RESULTS: While in the ICU, 329 of the 387 patients (85%) were prescribed SUP medications. Of the 233 patients who had not been taking acid-suppressive medications before admission to the ICU, 190 were prescribed SUP medications in the ICU. Of these 190 patients, most (63%) had their SUP continued in the ward without any obvious indication, and many (39%) had their SUP medications inappropriately continued on discharge from hospital. CONCLUSIONS: SUP medications commenced in ICU are frequently continued unnecessarily, both in the wards and hospital discharge.
Subject(s)
Anti-Ulcer Agents/therapeutic use , Continuity of Patient Care , Critical Care/methods , Intensive Care Units , Stomach Ulcer/prevention & control , Stress, Psychological/complications , Adult , Aged , Endoscopy, Gastrointestinal , Female , Follow-Up Studies , Humans , Male , Medication Errors/statistics & numerical data , Middle Aged , Prognosis , Retrospective Studies , Stomach Ulcer/diagnosis , Stomach Ulcer/etiology , Stress, Psychological/therapyABSTRACT
OBJECTIVE: To determine how frequently stress ulcer prophylaxis (SUP) medications prescribed in the intensive care unit are inappropriately continued on the ward and on hospital discharge. DESIGN: Retrospective cohort study; chart review. SETTING: Two Australian ICUs: one tertiary centre and one metropolitan centre. PARTICIPANTS: We included 387 adult, non-pregnant patients who were admitted to the ICU between 1 February 2011 and 31 March 2011 and who survived to hospital discharge. MAIN OUTCOME MEASURES: Rate of unnecessary continuation of ICU-prescribed SUP medications on the ward and on discharge from hospital. RESULTS: While in the ICU, 329 of the 387 patients (85%) were prescribed SUP medications. Of the 233 patients who had not been taking acid-suppressive medications before admission to the ICU, 190 were prescribed SUP medications in the ICU. Of these 190 patients, most (63%) had their SUP continued in the ward without any obvious indication, and many (39%) had their SUP medications inappropriately continued on discharge from hospital. CONCLUSIONS: SUP medications commenced in ICU are frequently continued unnecessarily, both in the wards and on hospital discharge.
Subject(s)
Delivery of Health Care/standards , Patient-Centered Care/standards , Quality Assurance, Health Care/methods , Quality Improvement/trends , Humans , United States/epidemiologyABSTRACT
OBJECTIVE: The development of an effective therapeutic equivalence program (TEP) through the collaborative support of medical staff, using the principles of disinvestment. DESIGN AND SETTING: A TEP was introduced at Southern Health, a metropolitan health service in Melbourne, in the 2006-07 financial year. Therapeutic classes were selected for the TEP by stakeholder consensus, and a preferred medication for each class was selected on the basis of cost considerations and therapeutic equivalence. New patients were commenced on preferred medicines, but patients receiving another medicine from a therapeutic class included in the program were not automatically switched to the preferred medicine. For the first 4 years of the program, prescribing patterns were monitored, and savings achieved (due to lower prices for and increased use of preferred medicines) were calculated on a monthly basis. MAIN OUTCOME MEASURES: Prescribing trends for preferred medicines, as a measure of acceptance of the TEP, and savings produced by the program. RESULTS: Over the 4-year study period, 11 therapeutic classes were targeted. The use of all preferred medicines increased once they become part of the TEP and a total of $3.16 million was saved. The annual savings increased each year, and the rate of increase was six times that of the increase in patient separations. CONCLUSIONS: The TEP at Southern Health resulted in significant savings. It showed that, by using a collaborative and evidence-based approach, the principles of disinvestment can be applied to use of medicines.