Evaluating Stress Ulcer Prophylaxis Appropriateness across a Multi-Hospital Health System

Document Type

Conference Proceeding

Publication Date

3-6-2026

Publication Title

Am J Health Syst Pharm

Keywords

Pharmacology & Pharmacy

Abstract

Purpose: A large proportion of adult inpatients receive stress ulcer prophylaxis (SUP) with histamine-2 receptor antagonists (H2RAs) or proton pump inhibitors (PPIs). While SUP is appropriate in certain circumstances, it may be overutilized due to delayed uptake of recent literature and evolving guidelines. At a multi-hospital health system, policies have been developed to guide clinicians on SUP initiation and discontinuation to ensure appropriate risk reduction, minimize unnecessary exposure, reduce adverse events, and improve cost savings. The purpose of this study is to evaluate SUP prescribing and deprescribing practices across a multi-hospital health system to determine policy alignment. Methods: This retrospective medication-use evaluation will include adults ≥18 years old admitted between January 1 and June 30, 2025, with length of stay ≥48 hours who received inpatient SUP (PPI or H2RA) at a multihospital health-system using a single electronic health record and standardized SUP policies. Patients receiving SUP for alternate indications (Gastroesophageal reflux disease, active acid reflux, active gastrointestinal bleed, history of or active peptic ulcer disease, history of or active gastritis, history of or active esophagitis, active H.pylori treatment, or active gastric, esophageal, or duodenal perforation) will be excluded. The primary endpoint is the proportion of orders meeting policy-based indications: mechanical ventilation; active coagulopathy (International normalized ratio > 1.5 or platelets < 50,000/µL, not on anticoagulation); traumatic brain injury; spinal cord injury; high-dose steroids (>250 mg hydrocortisone, >65 mg prednisone/prednisolone, >50 mg methylprednisolone or >10 mg dexamethasone daily); or dual antiplatelet therapy with prior gastrointestinal bleed or concomitant therapeutic anticoagulation. Secondary endpoints include appropriate continuation of SUP while policy-based indications were present and appropriate discontinuation when policy-based indications resolved. Additional analyses will compare the overall appropriateness of initiation of PPIs versus H2RAs in relation to the health system policy. Data will be extracted from the EHR digitally and manually validated for accuracy. Analyses will be descriptive, using basic statistics. Categorical comparisons will be performed using chi-square or fishers exact test as appropriate.

Volume

83

First Page

S811

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