Background: Studies have linked the use of anti-secretory agents to nosocomial complications including Clostridium difficile–induced pseudomembranous colitis and hospital acquired pneumonia. In the outpatient setting, the Federal Drug Administration has issued warnings regarding increased risk of hypomagnesemia as well as fractures of the hip, wrist, and spine with the use of proton pump inhibitors. Although evidence-based criteria for the initiation of anti-secretory agents in the hospital setting exist, the pervasiveness of anti-secretory agent overuse in the hospital continues to be a critical issue, compounded by the continued inappropriate prescription of these medications upon discharge from the hospital.
Methods: A retrospective review of patient data at a major teaching hospital in New York City was performed. During a 2 month study period, adult non-intensive care patients were randomly selected to determine the incidence of inappropriate initiation of stress ulcer prophylaxis on admission, as compared to the incidence of appropriate use. A follow-up assessment was then completed to determine the incidence of patients that were inappropriately discharged on these medications.
Results: A total of 100 randomly selected patients throughout the inpatient medicine service were analyzed. The results showed a high rate of inappropriate initiation and discharge of patients on anti-secretory agents.The study showed a 50% (n=50) incidence of overall stress ulcer prophylaxis use. Of the patients on stress ulcer prophylaxis, a 76% (n=38) incidence of inappropriate use was found. Of the patients inappropriately on stress ulcer prophylaxis, there was a 53% (n=19) incidence of inappropriate discharge home on these medications.
Conclusions: This study highlights the continued inappropriate initiation and discharge of patients on anti-secretory agents, despite mounting evidence and advisories against this practice. While an educational intervention on the appropriate use of anti-secretory agents is an important step towards better practice, the use of an electronic medical record provides an additional resource to improve quality of care. Electronic prescriptions allow for prompts that ask for a clinical indication during the prescription process. The advent of this technology may yield even more promising improvements in clinical practice, and its implementation is the current focus of a continuing study.