Evaluation to Determine the Utility of a Pharmacist-Driven Protocol to Discontinue Inappropriate Proton Pump Inhibitors or Histamine-2 Receptor Blockers in an Inpatient Setting
INTRODUCTION: Overutilization of proton pump inhibitors (PPIs) and histamine-2 receptor (H2R) blockers is a well-known and published statistic, especially when used for stress ulcer prophylaxis (SUP). Different strategies have attempted to avoid unnecessary use and adverse effects, as well as to decrease cost. RATIONALE/OBJECTIVE: Our study aims to determine the utility of a pharmacist-driven protocol; the protocol would authorize the pharmacists to discontinue inappropriate use of PPI or H2R blockers in the non-intensive care population. METHODS: Patient names were retrospectively obtained using a computer reporting system within the institution's electronic medical record. The system identified all patients admitted to the hospitalist service prescribed an oral PPI or H2R blocker during a one-month period. The charts were reviewed to determine whether one of these was a home medication or had documented indication(s) for their use. If neither of these criteria were met, the acid-suppressant medication could have been discontinued. The Institutional Review Board reviewed the protocol and determined non-study status. RESULTS: The patient's average age was 68.53 years. One hundred and thirty one charts were reviewed, 72% of which were excluded because the PPI or H2R blocker was a continuation of a home regimen. Ten charts had appropriate indications documented. Excluding these, 19.8% of patients on either a PPI or H2R blocker would have met criteria for discontinuation. DISCUSSION: The literature has shown that up to 56% of patients received SUP without appropriate indications. Our study evaluated patients for all indications. The lower percentage found in our study may be due to exclusion of intensive care patient, all provider groups, and patients prescribed either a H2R blocker or PPI prior to admission. CONCLUSION: This phase 1 study demonstrated a need for a pharmacist-driven protocol to decrease the inappropriate use of PPI or H2R blockers in the hospital setting.