Proton pump inhibitors (PPIs) are one of the most commonly prescribed medications. Numerous studies have shown that they are overused during inpatient admissions, despite being linked to an increased rate of pneumonia, Clostridium difficile infection, and fractures. We investigated the impact of an electronic indicationbased order set in reducing overuse of proton pump inhibitors in the inpatient population. Evidencebased UCSD guidelines on appropriate PPI use were developed by a multidisciplinary team and were programmed into an indicationbased order set within the hospital EMR. Appropriate use was defined as patients having PPI orders that matched one of the acceptable indications for PPI use as described in our guidelines.
This was a retrospective pre and postintervention study of appropriate PPI use before and after the implementation of a computerized order set. Patients who were started on a PPI during their admission to UCSDMC from June 1, 2010 to August 31, 2010 and from September 10, 2011 to October 20, 2011, represented the pre and postintervention cohorts, respectively. The postintervention analysis began after a two month “learning period” following order set implementation. Patients in both groups were evaluated for the appropriateness of prescribing a PPI. Patients who had a PPI already on their home medication list were excluded.
Preelectronic order set data was collected on 223 patients and revealed a 43% preintervention guideline adherence. Postimplementation data was collected on 127 patients and showed a 70% postintervention guideline adherence. Overall, there was a 27% reduction in PPI overuse after implementation, and this difference was statistically significant (OR 4.4, 95% CI 2.67.4, P < 0.001). A subgroup analysis was performed to evaluate appropriate use of PPIs for stress ulcer prophylaxis (SUP) before and after implementation of the order set. Preintervention guideline adherence for stress ulcer prophylaxis was 29%; postimplementation, guideline adherence was 52%. There was a 23% decrease in PPI overuse for SUP, and this difference was statistically significant (OR 2.4, 95% CI 1.15.4, P = 0.02).
An electronic indicationbased order set is an effective means to decrease overuse of PPIs in the inpatient setting, but additional measures are needed to achieve better compliance, especially when PPIs are ordered for stress ulcer prophylaxis.
To cite this abstract:Popa A, Clay B, Jenkins I, Koppenbrink K, Martin L, Helmons P. The Impact of an Electronic Order Set in Reducing Overuse of Proton Pump Inhibitors in the Inpatient Population. Abstract published at Hospital Medicine 2012, April 1-4, San Diego, Calif. Abstract 97601. Journal of Hospital Medicine. 2012; 7 (suppl 2). https://www.shmabstracts.com/abstract/the-impact-of-an-electronic-order-set-in-reducing-overuse-of-proton-pump-inhibitors-in-the-inpatient-population/. Accessed March 28, 2020.