ASHP Algorithm for Administering Stress Ulcer Prophylaxis in an Adult Patient in the ICU

Indications for stress prophylaxis: 1 or more risk factors (see previous section) for stress ulcerations

If the patient has gastric access (oral, nasogastric tube, gastrostomy) then sucralfate should be administered. If the patient has continuous nasogastric suction, then stop the suction for 2 hours after delivering the sucralfate.

If the patient does not have gastric access but does have enteral access (nasoenteral tube, ostomy) then administer an enteral H2-blocker.

If the patient does not have gastric or enteral access, then administer intravenous H2-blocker.

All patients in the ICU (both those receiving prophylaxis and those not) should be periodically assessed for the need to administer prophylaxis.