Benefit of an electronic medical record-based alarm in the optimization of stress ulcer prophylaxis

Abstract

Background: The use of stress ulcer prophylaxis (SUP) has risen in recent years, even in patients without a clear indication for therapy.

Aim: To evaluate the efficacy of an electronic medical record (EMR)-based alarm to improve appropriate SUP use in hospitalized patients.

Methods: We conducted an uncontrolled before-after study comparing SUP prescription in intensive care unit (ICU) patients and non-ICU patients, before and after the implementation of an EMR-based alarm that provided the correct indications for SUP.

Results: 1627 patients in the pre-intervention and 1513 patients in the post-intervention cohorts were included. The EMR-based alarm improved appropriate (49.6% vs. 66.6%, p<0.001) and reduced inappropriate SUP use (50.4% vs. 33.3%, p<0.001) in ICU patients only. These differences were related to the optimization of SUP in low risk patients. There was no difference in overt gastrointestinal bleeding between the two cohorts. Unjustified costs related to SUP were reduced by a third after EMR-based alarm use.

Conclusions: The use of an EMR-based alarm improved appropriate and reduced inappropriate use of SUP in ICU patients. This benefit was limited to optimization in low risk patients and associated with a decrease in SUP costs.

Keywords: Agentes gastrointestinales; Antagonistas del receptor H(2) de la histamina; Electronic medical records; Gastrointestinal agents; Histamine H2 antagonists; Historia clínica electrónica; Inhibidores de la bomba de protones; Intensive care unit; Prevención y control; Prevention and control; Proton pump inhibitors; Stomach ulcer; Unidad de cuidados intensivos; Úlcera gástrica.