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JCOM Abstract

J Clin Outcomes Manage 
2013 Jan;20(1):13-19
Efforts to reduce stress ulcer prophylaxis use in non-critically ill hospitalized patients by internal medicine residents: a single-institution experience
Jain G, Jabeen SA, Vallurupalli S

Abstract Objective: To examine the knowledge and attitudes of residents towards stress ulcer prophylaxis (SUP) and response to an intervention to decrease inappropriate use of SUP. Methods: SUP rate was calculated in a pre-intervention cohort of 100 consecutive non-critically ill patients admitted to the internal medicine service. Residents were surveyed regarding their knowledge and attitudes towards SUP and then engaged in a group discussion to identify issues leading to inappropriate prescription of SUP. Based on survey results, current practice patterns and evidence regarding SUP use were discussed during an educational conference. One year later, SUP rates were recalculated in a cohort of 100 patients. Results: Residents prescribed SUP to 74.1% of patients despite demonstrating good knowledge of SUP guidelines on the survey. Following the intervention, SUP rates decreased significantly to 28.6% (P < 0.001). However, the rate of inappropriate continuation of acid suppressive therapy at discharge did not change over the study period (35% vs. 35.7%, P = 0.603). Conclusions: Residents are prone to overprescribe SUP even when they possess adequate knowledge of guidelines and require guidance from attending physicians to develop good practice patterns. This, along with educational intervention, had a durable effect on reducing SUP use at our institution 1 year after the intervention. Inappropriate SUP prescription at discharge remains a problem and needs to be addressed.

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