Supportive and Preventive Medicine
Element
Importance
Considerations
Stress Ulcer
prophylaxis
Critically ill patients develop
stress-related mucosal damage,
potentially leading to clinically
significant bleeding
| • | Assess and evaluate the patient’s risk factors for stress |
|---|
ulcer bleeding
| • | Consider discontinuing acid-suppressive medications |
|---|
when risk factors are no longer present
Glycemic control
Glycemic control is necessary in
critically ill patients to decrease
the incidence of complications
such as decreased wound
healing, increased infection
risk, and increased risk of
polyneuropathy
| • | Maintaining blood glucose at 140–180 mg/ dL should be |
|---|
considered in the acutely ill patient
| • | Glycemic management protocols should be initiated for |
|---|
persistent hyperglycemia (blood glucose > 180 mg/dL)
in critically ill adults
| • | (See Fluids, Electrolytes, Acid-Based Disorders, and |
|---|
Nutrition Support chapter for a more in-depth review)
GI = gastrointestinal; ICU = intensive care unit; VTE = venous thromboembolism.
S = spontaneous breathing trial
B = bowel regimen
I = indwelling catheter removal
D = de-escalation of antimicrobials
M = medication reconciliation
A = antibiotics or anti-infectives
I = indications for medications
D = drug dosing
E = electrolytes, hematology, and other laboratory results
N = no drug interactions, allergies, duplications, adverse effects
S = stop dates
Provide a framework of standardization and regulation of interventions in a systematic manner, allowing
individuals to assess the presence or absence of the items.
increase compliance with evidence-based practices to improve outcomes in the ICU patient population
Increase identification of drug-related issues (Can J Hosp Pharm 2013;66:157-62; Pharmacy [Basel]
2022 30;10:74)