Reduction in Utilization of Intravenous Proton Pump Inhibitors Following Implementation of a Computerized Physician Order Entry Order Set

Background:

A number of studies reported in the literature suggest there is overuse of proton pump inhibitor (PPI) medications in hospitalized patients.

Purpose:

The goals of the study were to implement a computerized physician order entry (CPOE) order set for intravenous (IV) PPIs and to anlayze use patterns following this change.

Description:

A multidisciplinary committee was formed with both physician and pharmacist members. Guidelines for PPIs and stress ulcer prophylaxis were updated based on the current literature. A CPOE order set for IV PPIs in the inpatient setting was designed in which dosages and frequencies of administration of IV PPIs were standardized for various possible indications.

Ordering providers could view these guidelines via a Weblink embedded in the order set. IV PPI and histamine‐2 receptor antagonist (H2RA) use was determined from pharmacy records between October 2004 and June 2006 to assess the impact of the order set; implementation occurred in March 2005. The charts of 50 patients who had been prescribed IV PPIs prior to deployment of the order set and of another 50 patients following the intervention were retrospectively reviewed.

Conclusions:

Baseline IV PPI use was 909 doses/month in the preintervention period, with an average monthly cost of $5938. Postintervention, average IV PPI use was reduced to 664 doses/month (a 26.9% decrease), with an average monthly cost of $3967.

Providers were not simply substituting IV H2RAs. Average IV H2RA usage actually decreased from 1598 doses/month in the preintervention period to 1346 doses/month postintervention (a 15.7% decrease). Costs for IV H2RAs decreased from $6484/ month to $5430/month. Charts were reviewed looking for valid indications for IV PPIs before and after the intervention. Prior to implementation, 23 of 50 patients (46%) had an appropriate indication for an IV PPI. In 18 of the 50 patients (36%), “stress ulcer prophylaxis” was listed as the indication for IV PPI use; however, only 10 of the 18 (56%) met institutional criteria for stress ulcer prophylaxis. Postintervention, chart review showed appropriate indications for IV PPIs in 34 of 50 patients (68%). In 30 of the 50 patients (60%), “stress ulcer prophylaxis” was listed as the indication for IV PPI use, and 24 of those 30 (80%) met institutional criteria for stress ulcer prophylaxis. Astandardized evidence‐based order set for IV PPIs has led to a substantial reduction in use without limiting appropriate prescription of these medications. Annual cost savings from this intervention were estimated to be approximately $24,000.

Author Disclosure:

B. J. Clay, None.