Evaluation of Stress Ulcer Prophylaxis Use Among Adult Patients Admitted to the Intensive Care Unit in Northwest
Samuel Agegnew Wondm1, Samuel Berihun Dagnew1, Fisseha Nigussie Dagnew1
1Clinical Pharmacy Unit, Pharmacy Education and Clinical Service Directorate, College of Health Sciences Debre Tabor University Debre Tabor Ethiopia.
Background And Aim:
Stress-related mucosal bleeding among critically ill patients in intensive care unit (ICU) contributes substantially to morbidity and mortality. Despite growing concerns globally over inappropriate stress ulcer prophylaxis (SUP) use, limited data exist from Ethiopia, particularly in ICU settings. The objective of this study was to assess the appropriateness of SUP indications and associated factors among ICU-admitted patients in Northwest Ethiopia hospitals and to evaluate physicians' knowledge related to SUP prescribing practices.
Methods:
A multicenter cross-sectional study was conducted from June to December 2024 across three comprehensive specialized hospitals in Northwest Ethiopia. The American Society of Health-System Pharmacists (ASHP) criteria were applied to assess the appropriateness of SUP indications among ICU admitted adult patients. Additionally, a structured survey was administered to prescribers to evaluate their knowledge and attitudes regarding SUP. Binary logistic regression was used to identify factors associated with inappropriate SUP use, with a two-sided significance level of p < 0.05% and 95% confidence intervals (CI).
Results:
A total of 410 patients and 56 prescribers were included in the final analysis. Prescribers' knowledge regarding stress ulcer prophylaxis was suboptimal, with a mean knowledge score of 60.2%. Among patients receiving SUP, 64.4% of prescriptions were inappropriate, including 45.9% overutilization and 18.5% underutilization. Independent factors of inappropriate SUP use included older age ( ≥ 60 years) [AOR = 2.1; 95% CI: 1.2-3.3; p = 0.004] and longer hospital stays ( > 7days) [AOR = 3.1; 95% CI: 1.9-4.9; p = 0.001].
Conclusions:
Inappropriate use of SUP was widespread among ICU patients in Northwest Ethiopia. Older age and prolonged hospitalization were significantly associated factors. Regular prescriber education, involvement of clinical pharmacists, and routine audit with feedback are recommended to reduce inappropriate SUP use, particularly among older patients and those with prolonged hospital stays.
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