Impact of a pharmacist-driven protocol to decrease proton pump inhibitor use in non-intensive care hospitalized adults

Michal, Jessica; Henry, Thomas M.; Street, Connie

doi:10.2146/ajhp150519

Cited by 17 publications

(13 citation statements)

References 25 publications

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“…Furthermore, PPIs are also available for over-the-counter (OTC) purchase as part of self-care; however, with recent concerns about impurities of ranitidine and nizatidine (both H 2 RAs), patients may preferentially purchase OTC PPIs rather than H 2 RAs [112,113]. Therefore, a difficult and frequently-encountered clinical situation is not being able to determine why a patient is taking AST as the patient may not know or remember the indication, and/or the indication was never documented [38]. Prescribers encountering these patients in various settings may fear negative consequences or may not have adequate time and/or receive proper reimbursement to address AST appropriateness [32].…”

Section: Discussionmentioning

confidence: 99%

“…Inappropriate prescribing within the hospital setting and a growing list of serious adverse events associated with PPIs have prompted health care providers to develop various strategies to reduce inappropriate use [31]. These include deprescribing [12,[32][33][34], applying SUP guidelines, checklists and protocols [35][36][37][38], completing medication reconciliation activities [39,40], communicating concerns in-person and/or electronically [41][42][43][44], academic detailing [45], and educational campaigns [36,44,46,47].…”

Section: Introductionmentioning

confidence: 99%

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Impact of pharmacy-supported interventions on proportion of patients receiving non-indicated acid suppressive therapy upon discharge: A systematic review and meta-analysis

et al. 2020

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Objective Conduct a systematic review and meta-analysis to estimate the impact of pharmacy-supported interventions on the proportion of patients discharged from the hospital on inappropriate acid suppressive therapy (AST). Methods To identify studies, the following databases were systematically searched on October 14th, 2018 and repeated on September 12th, 2019: Ovid MEDLINE(R) and In-Process & Other Non-Indexed Citations and Daily, Embase.com, CINAHL, Web of Science, Cochrane CENTRAL (EBSCO), and ClinicalTrials.gov. Eligible studies consisted of adults, intervention and historical/usual care groups, description of active pharmacy-supported intervention, and proportion of patients discharged on inappropriate AST. Qualitative assessments and quantitative analyses were performed. Modified funnel plot analysis assessed heterogeneity. Preferred reporting items of systematic reviews and meta-analyses (PRISMA) methodology was used to evaluate studies in this review. Results Seventeen publications resulting in 16 studies were included in the review. Using random effects model, meta-analysis showed a significant reduction in the odds of being discharged on inappropriate AST from the hospital in the pharmacist-supported intervention arm versus comparator (Odds Ratio 0.33 [95%CI 0.20 to 0.53]), with significant heterogeneity (I2 = 86%). Eleven studies favored pharmacy-supported interventions, four were inconclusive and one favored usual care. Using modified funnel plot analysis, our final evaluation was distilled to 11 studies and revealed a similar outcome (OR 0.36 [95%CI 0.27 to 0.48]), but with less heterogeneity (I2 = 36%). Conclusion This systematic review and meta-analysis showed that pharmacy-supported interventions were associated with a significantly reduced probability of patients discharged on inappropriate AST. However, heterogeneity was high and may affect interpretation of results. Using funnel plot optimization method, three positive and two negative studies were objectively removed from analyses, resulting in a similar effect size, but with less heterogeneity. To improve study quality, future researchers should consider utilizing a pre-post, multi-arm, prospective design with sampling randomization, training of data extractors (preferably two extractors), re-evaluating a small dataset to check for agreement and providing a comprehensive methodology in subsequent publications.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Impact of pharmacy-supported interventions on proportion of patients receiving non-indicated acid suppressive therapy upon discharge: A systematic review and meta-analysis

et al. 2020

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“…A multicentre, cluster randomized, controlled trial showed that special pharmacists could play important role in reducing the frequency of a series of clinically important prescription and medication monitoring errors [ 21 ]. Recently, studies showed that pharmacist intervention decreased PPIs use in non-ICU hospitalized patients and overutilization of SUP in medical and surgical ICU [ 22 , 23 ]. A retrospective study discovered that the relative reduction in the rate of inappropriate SUP in general ward patients was 83.5% after implementing pharmacist SUP managed program [ 24 ].…”

Section: Introductionmentioning

confidence: 99%

Impact of clinical pharmacist interventions on inappropriate prophylactic acid suppressant use in hepatobiliary surgical patients undergoing elective operations

et al. 2017

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ObjectiveTo evaluate the impact and cost-benefit of clinical pharmacist interventions on inappropriate use of prophylactic acid suppressant in hepatobiliary surgical patients in a Chinese tertiary hospital.MethodsA retro-prospective intervention study of patients undergoing elective operations was performed in the Department of Hepatobiliary Surgery of the Affiliated Hospital of Southwest Medical University. Patients admitted from October to December 2015 and from October to December 2016, served as the pre-intervention and the post-intervention group, respectively. Clinical pharmacist interventions in the post-intervention group included real-time monitoring medical records and recommending that surgeons prescribe prophylactic acid suppressants according to the criteria established by the hospital administration. Then, the clinical outcomes of post-intervention group were compared with the pre-intervention group which lacked pharmacist interventions. In addition, cost-benefit analysis was conducted to determine the economic effects of implementing the clinical pharmacist interventions in acid suppressant prophylaxis in perioperative period.ResultsClinical pharmacist interventions significantly decreased the rate of the use of no indications for prophylactic acid suppressant and of the cases of inappropriate drug selection, dose, route, replacement and prolonged duration of prophylaxis (P < 0.05 or P < 0.001), resulting in significant increase by 10.65% in the percentage of cases adhering to all the criteria (P < 0.001). Moreover, significant reductions were found in the average usage quantity (P<0.001), mean cost (P = 0.03) and mean duration (P < 0.001) of prophylaxis acid suppressant. The ratio of the mean cost savings for acid suppressants to the mean cost of pharmacist time was 13.61:1.ConclusionThe clinical pharmacist’s real-time interventions facilitated the rational use of prophylactic acid suppressant and resulted in favorable economic outcomes in hepatobiliary surgery.

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“…This estimation was based on three studies, one of which was from previous internal data of a prior study, that were all quasi-experimental in design with a primary end point focusing on the difference in inappropriate continuation of a medication post implementation of an intervention. [30][31][32] Data results are presented as median with interquartile ranges (IQR). Continuous variables were compared using a Mann-Whitney U test.…”

Section: Discussionmentioning

confidence: 99%

Pharmacist‐driven discontinuation of antipsychotics for ICU delirium: A quasi‐experimental study

Stuart

Smith

Payter

et al. 2020

J Am Coll Clin Pharm

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Introduction The use of antipsychotics reduces the duration of intensive care unit (ICU) delirium. Continuation of antipsychotics prescribed for ICU delirium at hospital discharge has been an increasingly reported phenomenon with risk factors for continuation upon discharge identified. Objective To evaluate a pharmacist‐driven discontinuation protocol on the rate of patients with an antipsychotic continued at hospital discharge for ICU delirium. Methods This was a single‐center, retrospective quasi‐experimental study of patients admitted to the medical, surgical, or cardiac ICU started on antipsychotics for delirium. A protocol was developed for pharmacists to discontinue scheduled antipsychotics once delirium had resolved. The pre‐ and post‐protocol groups included patients between November 2015 to April 2016 and November 2017 to April 2018, respectively. The primary outcome was the rate of antipsychotic continuation at hospital discharge in the pre‐ and postprotocol groups. Secondary outcomes were related to antipsychotic use and adverse events. Chi‐square, Fisher's exact test, Mann‐Whitney U test, and t‐test were used as appropriate. Results A total of 158 patients were included. There were no differences in baseline demographics including age, gender, ICU type, baseline QTc, ICU length of stay (LOS) or hospital LOS (25 [13, 34] vs 19 [13, 30] days; P > .05). There was a significant reduction in the rate of antipsychotics continued at hospital discharge with 26 (32.9%) and 6 (7.6%) patients having therapy continued in the pre‐ and postprotocol groups, respectively (P < .001). No differences were noted in antipsychotic continuation upon transfer to floor, QTc prolongation, or recurrence of delirium within 7 days of antipsychotic discontinuation. Conclusions Implementation of a pharmacist‐driven antipsychotic discontinuation protocol for delirium was associated with a significant decrease in antipsychotic continuation at hospital discharge. The protocol did not result in a significantly higher incidence of QTc prolongation or recurrence of delirium. Future studies are needed to assess antipsychotic discontinuation in the ICU setting.

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Impact of a pharmacist-driven protocol to decrease proton pump inhibitor use in non-intensive care hospitalized adults

Abstract: The pharmacist-driven protocol described in this study decreased PPI use in non-ICU hospitalized adults.

Cited by 17 publications

References 25 publications

Impact of pharmacy-supported interventions on proportion of patients receiving non-indicated acid suppressive therapy upon discharge: A systematic review and meta-analysis

Impact of pharmacy-supported interventions on proportion of patients receiving non-indicated acid suppressive therapy upon discharge: A systematic review and meta-analysis

Impact of clinical pharmacist interventions on inappropriate prophylactic acid suppressant use in hepatobiliary surgical patients undergoing elective operations

Pharmacist‐driven discontinuation of antipsychotics for ICU delirium: A quasi‐experimental study

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