Collaboratively Designed Practice Guidelines Promote Appropriate Use of Intravenous Proton Pump Inhibitors

Abstract

Objective To determine the effectiveness of practice guidelines for proton pump inhibitor use at an academic medical center. Methods Patients initiated on intravenous (IV) pantoprazole therapy between July 2001 and May 2002 were evaluated prospectively for appropriateness of therapy. Pharmacists assessed clinical use, dosing strategy, administration route, and prescribing patterns. Results A total of 85 patients were evaluated. Only 25% of the patients were prescribed IV pantoprazole according to established institutional guidelines. The majority of therapy meeting guideline criteria were initiated on pantoprazole by the Gastroenterology service. Due to overuse of pantoprazole, prescribing guidelines were revised to specify indications with proven efficacy (erosive GERD, Zollinger-Ellison or other hypersecretory conditions, and upper gastrointestinal bleeding). Patients who received pantoprazole for stress ulcer prophylaxis, an unapproved indication, had therapy automatically switched to a histamine receptor antagonist. For patients who tolerated oral medications or enteral feedings, therapy was automatically converted to the oral dosage form. Conclusions Evaluation of institutional pantoprazole utilization revealed usage extending beyond indications with proven efficacy. Pharmacists and physicians collaboratively developed evidence-based practice guidelines; adherence to appropriate indications showed a 50% improvement.

Audit of IV pantoprazole: pattern of administration and compliance with guideline in a teaching hospital

“…American heart association and American College of Cardiology in 2007 suggested gastric acid suppression for the prevention of GI bleeding in patients taking antiplatelet therapy, 1 but since PPIS have the potential to inhibit cyp2c19isoenzymes, they may interact with Clopidogrel effects. This fact makes H2 antagonist first choice for this indication (Skledar and Culley 2005 ).…”

Impact of multi-approach strategy on acid suppressive medication use in a teaching hospital in Qatar

“…The fourth strategy was ensuring that the clinical pharmacists were on ''high alert'' during the clinical rounds and (21) 28 (14) Hepatic failure 13 (6) 13 (6) Bedridden 12 (6) 38 (18) a Chronic diseases include: diabetes mellitus, hypertension, congestive heart disease and chronic obstructive pulmonary disease at the time of the patient's discharge. Assessing and re-assessing the need of an ASM at any prescribing stage was done on a daily basis.…”

“…However, they are prescribed to the majority of hospitalized patients often without a certain indication or justified reason, especially in non-intensive care units [1][2][3][4][5][6][7]. The reported use of ASM in general medicine inpatients ranges from 26.8 to 71% [4].…”

“…More success however is expected from these initiatives when it is based on multiple strategies that are actively implemented [9]. Collaborative work between pharmacists and physicians to develop evidence-based practice guidelines resulted in a 50% improvement in the correct use of PPIs [6]. Regal et al found that combining a beginning-ofyear lecture to all interns with an early-in-the-month rotation reminder lecture and rounding of clinical pharmacists with healthcare teams reduced the inappropriate ASM usage from 59 to 19%, while the usage of PPIs reduced from 66 to 53% [8].…”

Proton pump inhibitors – are they truly safe?

“…Według Skledar i Culley dożylne podawanie pantoprazolu w badanym przez autorów ośrodku akademickim było zgodne z wytycznymi jedynie w 25% przypadków. Pozostałych 75% terapii rozpoczętych z niewłaściwych wskazań przeprowadzono głównie na oddziałach zabiegowych -potransplantacyjnych, torakokardiologicznych i chirurgii ogólnej [27].…”