title: Proton pump inhibitors for prophylaxis of nosocomial upper gastrointestinal tract bleeding: effect of standardized guidelines on prescribing practice.
abstract: BACKGROUND
  Proton pump inhibitors (PPIs) are frequently prescribed for prophylaxis of nosocomial upper gastrointestinal tract bleeding. Some inpatients receiving PPIs may have no risk factors for nosocomial upper gastrointestinal tract bleeding, and PPIs may be continued unnecessarily at hospital discharge. We aimed to assess the effect of standardized guidelines on PPI prescribing practices.
  
  
  METHODS
  Guidelines for PPI use were implemented on the medical service at a tertiary center. We reviewed PPI use among inpatient admissions during the month before implementation of guidelines and then prospectively evaluated PPI use among admissions during the month after implementation of guidelines.
  
  
  RESULTS
  Among an overall cohort of 942 patients, 48% were prescribed PPIs while inpatients, and 41% were prescribed PPIs at hospital discharge. Univariate predictors of inpatient PPI use included age, length of hospital stay, history of gastroesophageal reflux disease or upper gastrointestinal tract bleeding, and outpatient PPI, aspirin, or glucocorticoid use. Among patients not on an outpatient regimen of PPIs at admission, implementation of guidelines resulted in lower rates of inpatient PPI use (27% before vs 16% after, P = .001) and PPI prescription at discharge (16% before vs 10% after, P = .03).
  
  
  CONCLUSIONS
  Introduction of standardized guidelines resulted in lower rates of PPI use among a subset of inpatients and reduced the rate of PPI prescriptions at discharge.
authors.affiliation: Gastrointestinal Unit, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA. patrick.yachimski@vanderbilt.edu
authors.forename: Patrick S
authors.initials: PS
authors.lastname: Yachimski
authors.forename: Elizabeth A
authors.initials: EA
authors.lastname: Farrell
authors.forename: Daniel P
authors.initials: DP
authors.lastname: Hunt
authors.forename: Andrea E
authors.initials: AE
authors.lastname: Reid
mesh_terms: D001900:Boston; D005260:Female; D006471:Gastrointestinal Hemorrhage / Q000517:prevention & control*; D019983:Guideline Adherence; D006801:Humans; D007297:Inpatients; D016015:Logistic Models; D008297:Male; D008505:Medical Staff, Hospital; D008875:Middle Aged; D010438:Peptic Ulcer Hemorrhage / Q000517:prevention & control; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians'; D011446:Prospective Studies; D054328:Proton Pump Inhibitors / Q000627:therapeutic use*
chemical_list: D054328:Proton Pump Inhibitors
references.citation: Am J Gastroenterol. 2006 Oct;101(10):2200-5
references.pmid: 16952283
references.citation: Am J Gastroenterol. 2009 Mar;104 Suppl 2:S17-20
references.pmid: 19262541
references.citation: BMC Health Serv Res. 2007 Nov 05;7:177
references.pmid: 17983477
references.citation: Am J Gastroenterol. 2008 Sep;103(9):2308-13
references.pmid: 18702653
references.citation: N Engl J Med. 1998 Mar 19;338(12):791-7
references.pmid: 9504939
references.citation: Ann Pharmacother. 2006 Jul-Aug;40(7-8):1261-6
references.pmid: 16804095
references.citation: Am J Gastroenterol. 2009 Mar;104 Suppl 2:S10-6
references.pmid: 19262540
references.citation: Am J Gastroenterol. 2000 Nov;95(11):3118-22
references.pmid: 11095327
references.citation: Ann Intern Med. 2008 Sep 16;149(6):391-8
references.pmid: 18794558
references.citation: BMC Med Inform Decis Mak. 2009 Feb 11;9:11
references.pmid: 19210782
references.citation: Chest. 2009 Aug;136(2):440-447
references.pmid: 19318661
references.citation: JAMA. 2009 May 27;301(20):2120-8
references.pmid: 19470989
references.citation: J Clin Gastroenterol. 2008 Apr;42(4):368-72
references.pmid: 18277903
references.citation: JAMA. 2005 Dec 21;294(23):2989-95
references.pmid: 16414946
references.citation: Eur J Gastroenterol Hepatol. 2008 Jul;20(7):608-12
references.pmid: 18679061
references.citation: Aliment Pharmacol Ther. 2009 Mar 15;29(6):626-34
references.pmid: 19183143
references.citation: J Am Med Dir Assoc. 2007 Nov;8(9):607-9
references.pmid: 17998118
references.citation: Aliment Pharmacol Ther. 2005 May 15;21(10):1203-9
references.pmid: 15882240
references.citation: N Engl J Med. 1994 Feb 10;330(6):377-81
references.pmid: 8284001
references.citation: JAMA. 2006 Dec 27;296(24):2947-53
references.pmid: 17190895
references.citation: JAMA. 2009 Mar 4;301(9):937-44
references.pmid: 19258584
references.citation: Am J Gastroenterol. 2009 Mar;104 Suppl 2:S2-4
references.pmid: 19262542