title: Unexplained abdominal pain as a driver for inappropriate therapeutics: an audit on the use of intravenous proton pump inhibitors.
abstract: Background. Proton pump inhibitors (PPIs) are currently the most effective agents for acid-related disorders. However, studies show that 25-75% of patients receiving intravenous PPIs had no appropriate justification, indicating high rates of inappropriate prescribing. Objective. To examine the appropriate use of intravenous PPIs in accordance with guidelines and the efficacy of a prescribing awareness intervention at an Asian teaching institution. Setting. Prospective audit in a tertiary hospital in Malaysia. Method. Every 4th intravenous PPI prescription received in the pharmacy was screened against hospital guidelines. Interventions for incorrect indication/dose/duration were performed. Patients' demographic data, medical history and the use of intravenous PPI were collected. Included were all adult inpatients prescribed intravenous PPI. Main Outcome Measure. Proportion of appropriate IV PPI prescriptions. Results. Data for 106 patients were collected. Most patients were male [65(61.3%)], Chinese [50(47.2%)], with mean age ± SD = 60.3 ± 18.0 years. Most intravenous PPI prescriptions were initiated by junior doctors from the surgical [47(44.3%)] and medical [42(39.6%)] departments. Only 50/106(47.2%) patients had upper gastrointestinal endoscopy/surgery performed to verify the source of bleeding. Unexplained abdominal pain [81(76.4%)] was the main driver for prescribing intravenous PPIs empirically, out of which 73(68.9%) were for suspected upper gastrointestinal bleed. Overall, intravenous PPI was found to be inappropriately prescribed in 56(52.8%) patients for indication, dose or duration. Interventions on the use of intravenous PPI were most effective when performed by senior doctors (100%), followed by clinical pharmacists (50%), and inpatient pharmacists (37.5%, p = 0.027). Conclusion. Inappropriate intravenous PPI usage is still prevalent despite the enforcement of hospital guidelines. The promotion of prescribing awareness and evidence-based prescribing through education of medical staff could result in more judicious use of intravenous PPI and dose-optimization.
authors.affiliation: Department of Primary Care Medicine, University Malaya Primary Care Research Group (UMPCRG), Faculty of Medicine, University of Malaya , Kuala Lumpur , Malaysia ; Pharmacy Department, University Malaya Medical Centre , Kuala Lumpur , Malaysia.
authors.forename: Pauline Siew Mei
authors.initials: PS
authors.lastname: Lai
authors.affiliation: Pharmacy Department, University Malaya Medical Centre , Kuala Lumpur , Malaysia.
authors.forename: Yin Yen
authors.initials: YY
authors.lastname: Wong
authors.affiliation: Pharmacy Department, University Malaya Medical Centre , Kuala Lumpur , Malaysia.
authors.forename: Yong Chia
authors.initials: YC
authors.lastname: Low
authors.affiliation: Pharmacy Department, University Malaya Medical Centre , Kuala Lumpur , Malaysia.
authors.forename: Hui Ling
authors.initials: HL
authors.lastname: Lau
authors.affiliation: Department of Surgery, Faculty of Medicine, University of Malaya , Kuala Lumpur , Malaysia.
authors.forename: Kin-Fah
authors.initials: KF
authors.lastname: Chin
authors.affiliation: Department of Medicine, Faculty of Medicine, University Malaya , Kuala Lumpur , Malaysia.
authors.forename: Sanjiv
authors.initials: S
authors.lastname: Mahadeva
keywords: Appropriate clinical use; Audit; Gastrointestinal bleeding; Intravenous proton pump inhibitor