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Impact of clinical pharmacists on adherence to stress ulcer prophylaxis protocol in critically ill Egyptian patients: a comparative study

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Standardized protocols can aid in appropriate prescribing of stress ulcer prophylaxis (SUP) in the intensive care unit (ICU). The study aimed to evaluate the impact of providing a physician’s education (PhyEd) versus a PhyEd + Clinical Pharmacist (PhyEd + CPh) approach on adherence to a SUP protocol and possible cost saving in the ICU.


This was a quasi-experimental study. An evidence-based SUP protocol was developed by a clinical pharmacy team at an Egyptian ICU. Physicians were provided with educational sessions, information regarding the protocol, and latest SUP guidelines over a 1-month period. All adult patients admitted to one of the two ICU floors during the 6-month study period were eligible for inclusion. Patients admitted with an indication for acid suppressive therapy and those who stayed in the ICU for < 48 h were excluded. Patients were divided into two groups based on their ICU floor: PhyEd (1st floor) and PhyEd + CPh (2nd floor). Clinical pharmacists provided interventions regarding protocol adherence only for patients on the 2nd floor.


A total of 177 patients were included. SUP protocol non-adherence, calculated as the percentage of inappropriate (i.e., did not meet all the criteria in the protocol) patient-days, was significantly lower in the PhyEd + CPh group than in the PhyEd group (64.7% vs 90.9%; p < 0.0001). Bleeding events were comparable in both groups. The total actual cost saved due to protocol adherence was $US149.44 ($US118.95 in the PhyEd + CPh group + $US30.49 in the PhyEd group). The estimated total cost saved due to protocol adherence was $US948.56.


Clinical pharmacists’ daily interventions decreased non-adherence to the SUP protocol, and provided a significant decrease in hospital expenditures with no influence on adverse effects.

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The authors would like to thank the clinical pharmacists Marwa Ali Hussein (PharmD, BCCCP) and Zeinab Bakry Mohamed for their contribution to data collection for this study. We would like also to thank the whole clinical pharmacy team and staff at the Critical Care Medicine Department, Cairo University Hospitals for their contributions in implementing the SUP protocol.

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Correspondence to Naglaa Samir Bazan.

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Author contributions

All authors were involved in the concept and design. NS Bazan collected the study data, performed the statistical analysis, interpreted the data, and wrote the first draft of the manuscript. All authors contributed to, and approved, the subsequent drafts.

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The datasets generated during and/or analyzed during the current study are available from the corresponding author on request.



Conflicts of interest

Naglaa Samir Bazan, Samar Farghali Farid, and Darrin Lloyd Baines declare that they have no conflicts of interest.

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Granted by the Research Ethics Committee at Faculty of Pharmacy, Cairo University, CL (2293).

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Consent was obtained from all participants.

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Bazan, N.S., Farid, S.F. & Baines, D.L. Impact of clinical pharmacists on adherence to stress ulcer prophylaxis protocol in critically ill Egyptian patients: a comparative study. Drugs Ther Perspect 37, 35–43 (2021).

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