Stress Ulcer Prophlyaxis: Investigating Overuse and Poor Adherence to Guidelines Across Two Teaching Hospitals IRB Protocol

A. Study Purpose and Rationale The most recent guidelines available on stress ulcer prophylaxis for hospitalized patients were published over a decade ago by the American Society of Health‐System Pharmacists [1] and based on current prescribing practices, appear to be either obsolete or ignored. According to a host of clinical studies, the benefit of acid suppressive therapy (AST), including PPIs and H2 blockers, is well defined in critical care patients with specific indications that convey elevated risk of stress‐related mucosal disease [2]. Over the past decade, the use of AST for stress ulcer prophylaxis (SUP) has become an increasingly common practice in general medicine patients with little evidence to support it. The risk of clinically significant bleeding from stress ulcer disease is exceedingly low and there are relatively few validated indications for prophylaxis. Despite, the use of these agents in the inpatient setting has become pervasive and indiscriminate; studies show that up to seventy percent of patients on general medical wards receive SUP without appropriate justification. While guidelines exist, they are outdated and for the younger generation of physicians, are either poorly understood or poorly applied. There has been a trend toward ‘knee jerk’ prescribing practices for AST particularly in teaching hospitals and among residents. This is compounded by institutional policies and order sets that allow for or encourage SUP use without demanding an indication or rationale. This study aims to identify the root of this problem: whether deficits exist in the knowledge or interpretation of SUP guidelines, at what level of training, and whether institutional policies perpetuate overprescribing trends. The goal is to inform potential quality improvement interventions in order to increase compliance with published guidelines and change practice patterns as a model for cost‐effective and safety‐oriented care.