5PSQ-002 Adherence to guidelines for treatment of upper and lower gastrointestinal bleeding in acute surgical wards

BackgroundThe drug treatment that patients receive for upper and lower gastrointestinal (GI) bleeds at surgical wards is not always in accordance with the guidelines. Patients sometimes stay on intravenous (IV) proton-pump inhibitors (PPIs) longer than necessary when oral treatment has been shown to be equally effective. Oral treatment is more convenient for patients and saves time for nurses. There is also a large difference in costs of treatment. The hypothesis for this study was that unnecessary treatment with IV PPIs is common and that measures to increase adherence to the guidelines are needed.PurposeTo measure how well the acute surgical wards at a university hospital follow the local guidelines for the treatment of lower and upper GI bleeds, and if costs can be saved when the guidelines are followed.Material and methodsThis study was a retrospective review of the treatment of patients with GI bleeds, using electronic medical records. Patients with the diagnoses of ventricular ulcer, duodenal ulcer and lower GI bleed who had been discharged from two acute surgical wards between July and December 2016 were included. Data on diagnostics, treatment and relevant patient characteristics were collected, deidentified and analysed descriptively.ResultsOne hundred and sixty-six patients were included, of which 40 (24%) were deemed by a pharmacist student to have received unnecessary IV treatment according to guidelines. The 40 patients either lacked a correct indication (n=2) or could have received oral treatment instead (n=38). The total number of days that patients were unnecessarily treated with intravenous PPI (esomeprazole 40 mgx2) was 79 and the cost of this amounted to €320 for the entire period. If these patients had instead received oral PPI treatment (omeprazole 40 mgx2) the costs of treatment would have been €0.8 for the entire period.ConclusionWhile almost a quarter of the patients received unnecessary IV PPI treatment, the total extra cost for this was not as large as had been anticipated. However, factors such as extra time spent by nurses, preparing and administrating IV drugs, and patient discomfort have not been scrutinised in this study. Efforts to improve adherence to guidelines will be undertaken because of this study.Reference and/or Acknowledgements1. Juhlin C. Gastrointestinal Blödning-Övre 20–01–2017.No conflict of interest