The Impact of an Electronic Order Set in Reducing Overuse of Proton Pump Inhibitors in the Inpatient Population

Meeting: Hospital Medicine 2012, April 1-4, San Diego, Calif.

Abstract number: 97601

Background:

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 indication–based order set in reducing overuse of proton pump inhibitors in the inpatient population. Evidence–based UCSD guidelines on appropriate PPI use were developed by a multidisciplinary team and were programmed into an indication–based 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.

Methods:

This was a retrospective pre– and post–intervention 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 post–intervention cohorts, respectively. The post–intervention 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.

Results:

Pre–electronic order set data was collected on 223 patients and revealed a 43% pre–intervention guideline adherence. Post–implementation data was collected on 127 patients and showed a 70% post–intervention guideline adherence. Overall, there was a 27% reduction in PPI overuse after implementation, and this difference was statistically significant (OR 4.4, 95% CI 2.6–7.4, 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. Pre–intervention guideline adherence for stress ulcer prophylaxis was 29%; post–implementation, 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 1.1–5.4, P = 0.02).

Conclusions:

An electronic indication–based 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 May 23, 2019.

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