Purpose: Proton pump inhibitors (PPIs) and histamine-2 receptor antagonists (H2 blockers) continue to be over utilized for stress ulcer prophylaxis (SUP). Our study aims to evaluate the effectiveness and feasibility of a pharmacist-driven termination protocol in a community teaching hospital to limit the inappropriate use of acid-suppressive medications in the non-intensive care unit (ICU) setting.
Methods: Patient charts were evaluated for the appropriate use of PPIs or H2 blockers. A centralized pharmacist contacted healthcare providers for medication discontinuation if the acid suppressant use was deemed inappropriate. The primary outcome of the study was the number of patients who had acid-suppressive medication discontinued after the implementation of the pharmacist-driven termination protocol.
Results: Acid-suppressive medication was inappropriately prescribed for nine patients. It was discontinued for eight of those patients based on the pharmacist-driven termination protocol; this was a statistically significant decrease (P < 0.001). The pharmacist spent, on average, less than one minute on each patient's chart.
Conclusion: Our study revealed that a pharmacist-driven termination protocol resulted in a 6% overall reduction rate in inappropriately used acid-suppressive medications, with little impact on pharmacist workflow. Implementing such a termination protocol could help to decrease the inappropriate use of acid-suppressive medications in an inpatient hospital service.
Keywords: antagonists; histamine-2; pharmacist; proton pump inhibitors; quality improvement.
Conflict of interest statement
Disclosure: There was no funding for this study. All authors had access to the data, and they all participated in writing and editing the manuscript. None of the authors have a conflict of interest. Dr. Kavanaugh owns a small amount of stock in Stryker.
Impact of a Pharmacist-Driven Protocol to Decrease Proton Pump Inhibitor Use in Non-Intensive Care Hospitalized AdultsJ Michal et al. Am J Health Syst Pharm 73 (17 Suppl 4), S126-32. PMID 27543598.The pharmacist-driven protocol described in this study decreased PPI use in non-ICU hospitalized adults.
A Successful Pharmacist-Based Quality Initiative to Reduce Inappropriate Stress Ulcer Prophylaxis Use in an Academic Medical Intensive Care UnitU Masood et al. Inquiry 55, 46958018759116. PMID 29502481.Stress ulcer prophylaxis (SUP) is often inappropriately utilized, particularly in critically ill patients. The objective of this study is to find an effective way of redu …
Impact of a Clinical Pharmacist Stress Ulcer Prophylaxis Management Program on Inappropriate Use in Hospitalized PatientsMS Buckley et al. Am J Med 128 (8), 905-13. PMID 25820164.The implementation of a pharmacist-managed stress ulcer prophylaxis program was associated with a decrease in inappropriate acid suppression rates during hospitalization …
Pharmacologic Prophylaxis of Stress Ulcer in Non-ICU Patients: A Systematic Review and Network Meta-analysis of Randomized Controlled TrialsY Liu et al. Clin Ther. PMID 32046894. - ReviewPPIs could significantly decrease SU bleeding risk without increasing ADEs than other acid-suppressive medications for SU prophylaxis in non-ICU patients. However, RCTs o …
Interventions for Preventing Upper Gastrointestinal Bleeding in People Admitted to Intensive Care UnitsI Toews et al. Cochrane Database Syst Rev 6 (6), CD008687. PMID 29862492. - ReviewThis review shows that antacids, sucralfate, and H2 receptor antagonists might be more effective in preventing upper GI bleeding in ICU patients compared with placebo or …