Compliance with Guidelines for Stress Ulcer Prophylaxis in
Surgical and Orthopedic Units at Ramathibodi Hospital
Supatat Chumnumwat PharmD1, Pitchaya Dilokpatanamongkol BCCCP1,
Thanapipat Wiriyanont PharmD candidate1, Thitiwut Sricholwattana PharmD candidate1,
Nantaporn Lekpittaya RPh, MS2, Paphon Sa-ngasoongsong MD3, Preeda Sumritpradit MD4
Affiliation :
1 Department of Pharmacy, Faculty of Pharmacy, Mahidol University, Bangkok, Thailand
2 Clinical Pharmacy Department, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
3 Department of Orthopedics, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
4 Department of Surgery, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
Objective : Evaluate the appropriateness of proton-pump inhibitors [PPIs] use for stress-related mucosal disease [SRMD] prophylaxis
in surgical and orthopedics units.
Materials and Methods : A retrospective chart review study was conducted among patients admitted to the surgical and orthopedic
units and received PPIs during their hospitalization at Ramathibodi Hospital between August 30, 2016 and January 18, 2017.
Demographic data, medical history, and pertinent laboratory tests were obtained from medical records. Available practice guidelines
and related clinical studies were utilized as references for assessing appropriateness of PPIs use. Prescribing PPIs not according
to the guideline is marked as inappropriate or improper.
Results : Of the 105 patients included in the present study, 58 patients (55.24%) were started on PPIs without indication as stated
in the guideline. Twenty-four patients (22.86%) were continued on PPIs during hospitalization while their risk factors for SRMD
was resolved. Twelve patients (11.43%) received PPIs dose inconsistent with the guideline, particularly too-high dose. Upon
discharge, 37 patients (35.24%) continued to receive PPIs without proper indication.
Conclusion : Improper use of PPI was common in surgical and orthopedics units. Monitoring for PPIs use is required to ensure
appropriate SRMD prophylaxis.
Keywords : Proton pump inhibitors, Stress, Ulcer, Prophylaxis, Acid-suppression
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