Andrew C. Faust is a critical care clinical pharmacist primarily working in the medical intensive care unit, Department of Pharmacy, Texas Health Presbyterian Hospital Dallas, Dallas, Texas.Kelly L. Echevarria is an infectious diseases and critical care clinical pharmacist, Department of Pharmacy, South Texas Veterans Health Care System, San Antonio, Texas.Rebecca L. Attridge is an associate professor, Department of Pharmacy Practice, University of the Incarnate Word Feik School of Pharmacy, and an adjunct assistant professor, Division of Pulmonary Diseases and Critical Care Medicine, Department of Medicine, UT Health San Antonio, San Antonio, Texas.Lyndsay Sheperd is a critical care clinical pharmacist primarily working in the surgical-trauma intensive care unit, Department of Pharmacy, Texas Health Presbyterian Hospital Dallas, Dallas, Texas.Marcos I. Restrepo is an associate professor in pulmonary and critical care medicine, Department of Medicine, Division of Pulmonary Diseases and Critical Care Medicine, University of Texas Health Science Center at San Antonio, and Veterans Evidence-Based Research Dissemination Implementation Center, South Texas Veterans Health Care System, San Antonio, Texas.
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Acid-suppressive therapy for prophylaxis of stress ulcer bleeding is commonly prescribed for hospitalized patients. Although its use in select, at-risk patients may reduce clinically significant gastrointestinal bleeding, the alteration in gastric pH and composition may place these patients at a higher risk of infection. Although any pharmacologic alteration of the gastric pH and composition is associated with an increased risk of infection, the risk appears to be highest with proton pump inhibitors, perhaps owing to the potency of this class of drugs in increasing the gastric pH. With the increased risk of infection, universal provision of pharmacologic acid suppression to all hospitalized patients, even all critically ill patients, is inappropriate and should be confined to patients meeting specific criteria. Nurses providing care in critical care areas may be instrumental in screening for appropriate use of acid-suppressive therapy and ensuring the drugs are discontinued upon transfer out of intensive care or when risk factors are no longer present.CE 1.0 hour, Pharma 0.75, CERP AThis article has been designated for CE contact hour(s). The evaluation tests your knowledge of the following objectives:1. Identify evidence-based indications for stress ulcer bleeding prophylaxis in both critically ill and noncritically ill patients2. Discuss the infectious risks associated with acid-suppressive therapy, including pneumonia and Clostridium difficile-associated diarrhea3. Develop evidence-based criteria for use and discontinuation of acid-suppressive therapyTo complete evaluation for CE contact hour(s) for activity #C1733, visit www.ccnonline.org and click the “CE Articles” button. No fee for AACN members.This CE activity expires on June 1, 2019.The American Association of Critical-Care Nurses is an accredited provider of continuing nursing education by the American Nurses Credentialing Center's Commission on Accreditation. AACN has been approved as a provider of continuing education in nursing by the State Boards of Registered Nursing of California (#01036) and Louisiana (#LSBN12).