Impact of trauma stress ulcer prophylaxis guidelines on drug cost and frequency of major gastrointestinal bleeding

Trauma patients are routinely prescribed stress ulcer prophylaxis despite e vidence suggesting such therapy be limited to patients with identifiable ri sk factors for bleeding. With surgeons' consensus, we developed and impleme nted trauma stress ulcer prophylaxis guidelines, and measured the impact of clinical pharmacists on implementing the guidelines and the effect of the guidelines on drug cost and frequency of major gastrointestinal bleeding. T wo groups of 150 consecutive patients admitted with multiple trauma were ev aluated before and after guideline implementation and stratified by Injury Severity Score (ISS) to minor (ISS < 9) or moderate to severe (ISS greater than or equal to 9) trauma groups. The number of patients prescribed stress ulcer prophylaxis, length and cost of this therapy, and number of patients experiencing major gastrointestinal bleeding (decrease in consecutive hemo globin greater than or equal to 2 g/dl in conjunction with coffee-ground em esis, hematemesis, melena, or hematochezia) were measured. All pharmacist i nterventions pertaining to stress prophylaxis were collected. Fewer patient s were prescribed stress ulcer prophylaxis after guideline implementation ( 105/150, 70% vs 39/150, 26%, p<0.0001), leading to a decrease in total drug cost of $4558. Use decreased more in patients with minor (40/54, 74% vs 9/ 59, 15%, p<0.0001) than moderate to severe (65/96, 68% vs 30/91, 33%, p<0.0 001) trauma. Neither length of therapy nor agent of choice (> 95% cimetidin e) differed between groups. Fifteen (38%) of 38 postguideline prophylaxis o rders were determined by the pharmacist not to meet guideline criteria. Rec ommendations to discontinue therapy were accepted in 9 (60%) of 15 instance s. The frequency of major gastrointestinal bleeding remained unchanged betw een groups (1/150 vs 0/150, p=1.0). Implementation of trauma stress ulcer p rophylaxis guidelines limiting therapy to patients with risk factors for bl eeding led to a 80% decrease in drug cost and did not affect the frequency of major gastrointestinal bleeding.