Multidisciplinary drug-use evaluation for stress ulcer prophylaxis

A process for creating a multidisciplinary approach to quality assurance within an intensive-care unit is described. A drug-use evaluation program for stress ulcer prophylaxis in the neurosurgical intensive-care unit (NSICU) was developed by a pharmacist with the cooperation of physicians and nurses at the institution. First, the pharmacist worked with the gastrointestinal medicine division to develop indicators for appropriate prophylaxis and monitoring of stress ulcers in patients admitted to the NSICU. The physicians in the neurosurgical division were then given an opportunity to modify or approve the indicators. Before the indicators went into effect as the standard of care, inservice education was provided and pocket cards outlining the criteria were developed. Data were collected on all patients admitted to the NSICU over one year. The data are being reviewed to determine the clinical efficacy and safety of all regimens used, and this information will be used to revise the criteria and influence subsequent prescribing practices in the unit. The program has led to changes in nursing, medical, and pharmacy practice in the unit. Pharmacists can work with other health-care professionals in developing a program to obtain clinically relevant data for a specific group of patients and thus help to improve patient care.