Pharmacy and Pharmaceutical Sciences
University of Alberta
Summary of research:
Background: No critically ill child should receive unnecessary medications. Despite limited data on the effectiveness of prophylaxis, most critically ill children are prescribed either a proton-pump inhibitor or a histamine-2 receptor antagonist to prevent stress ulcer-related gastrointestinal bleeding. Clinically important bleeding may be decreasing with modern PICU care and the risks such as ventilator associated pneumonia and C. difficile infection may have been underestimated. Thus the risk/benefit ratio is uncertain. A large, multicentre RCT is needed, but we need important information to ensure that such a trial is successful. Although, as medication experts, pharmacists play an integral role in clinical care, they have a smaller role in research: in a Canadian survey, 80% wanted to be involved in more research. Objectives: Our objectives are to: (1) describe current stress ulcer prophylaxis practice patterns in Canadian PICUs (2) estimate the number of potential participants for a future randomized controlled trial (3) encourage collaborative, innovative research among Canadian PICU pharmacists. Design: Multi-centre prospective audit of practice patterns. Methods: The pharmacist(s) working in each participating PICU will collect data on all ventilated patients daily. The data collected focus on stress ulcer prophylaxis, other PICU interventions, concomitant medications and adverse effects (GI bleeding, C difficile, and new respiratory infections). We will include at least 10 Canadian PICUs and will screen for two 4-week periods. We anticipate enrolling at least 300 children. Key outcomes: (1) By providing each unit with data on their own current prescribing practice, this will represent a quality improvement initiative, offering baseline data on a quality of care metric. This research model may foster the pursuit of other quality improvement initiatives important to each unit, such as the choice of route or agent and discontinuation on discharge from the PICU. (2) Through this project we will develop a network of PICU pharmacists who are interested in collaborating on research. This project is an important opportunity to foster the development of formal and informal linkages and increase their research experience and expertise. These connections and this study as a prototype will enable future multi-centre research projects by this group (3) This study will provide critical information for planning an urgently needed large RCT to test a widely used intervention supported by little data.