The rationality of continuous improvement of stress ulcer preventive medication by orthopedic clinical pharmacists in tertiary teaching hospitals

Objective: We aim to evaluate the efficacy of clinical intervention by clinical pharmacists in improving prophylactic medication for stress ulcer, and explore the application of Plan-Do-Check-Act (PDCA) in promoting rational stress ulcer prophylaxis (SUP). Methods: : We conducted a retrospective study of 1702 patients in the Department of Orthopedics at a tertiary teaching hospital in China from January 2021 to October 2022. 778 and 924 patients were included in the pre-PDCA and post-PDCA groups, respectively. Clinical pharmacists established the criteria for SUP and conducted interventions, including doctor's prescription review, opinion feedback, clinical education and result analysis. We analyzed the improvement of irrational drug use and medical cost in stress ulcer prophylaxis before and after the establishment of PDCA cycle. Results: : Clinical pharmacist-led continuous intervention and PDCA cycle significantly reduced the incidence of irrational SUP (79.31% vs. 23.41%), including medication duration, indications, usage and drug selection. The average duration of use of acid-suppressive drugs in each patient (days 3.90±2.29 vs. 2.68±1.97) the average SUP cost (CNY 166.58±116.25 vs. 126.48±104.16) and inappropriate SUP cost (CNY 70.40±84.47 vs. 25.53±68.66) were significantly decreased. The target compliance rate was 109.41%. Conclusions: : Clinical pharmacists can effectively improve irrational SUP through PDCA cycle to optimize drug use, so as to obtain better clinical and economic outcomes.