Use of Intravenous Proton-Pump Inhibitors in a Teaching Hospital Practice

被引:20
作者
Hoover, Jacob G. [1 ]
Schumaker, Annabel L. [1 ]
Franklin, Kevin J. [1 ]
机构
[1] Wilford Hall USAF Med Ctr, Dept Internal Med, Lackland AFB, TX 78236 USA
关键词
Cost; Intravenous; Military; Prescribing habits; Proton-pump inhibitor; COST-EFFECTIVENESS ANALYSIS; DOSE OMEPRAZOLE INFUSION; ENDOSCOPIC TREATMENT; PEPTIC-ULCER; RISK-FACTORS; THERAPY; PANTOPRAZOLE;
D O I
10.1007/s10620-008-0568-4
中图分类号
R57 [消化系及腹部疾病];
学科分类号
摘要
Objective To evaluate intravenous proton-pump inhibitor (IV PPI) prescribing in a single academic teaching hospital. Methods A retrospective pilot study of 107 patients in a single United States military teaching hospital was conducted over a 1-month period. Clinical data were collected and analyzed for demographic features, prior medication use, admission hemoglobin level, service prescribing the IV PPI, indication for IV PPI, IV PPI treatment duration, gastroenterology consultant use, endoscopic findings, and blood products given. Indications for use were compared with current established guidelines to determine appropriate usage. Results A total of 683 doses of IV pantoprazole were prescribed over a 1-month period. Seventy-six patients (71%; 95% confidence interval [CI], 62-79%) who received IV PPIs did not meet the criteria for an appropriate indication for use. Ninety-nine patients in the study (93%; 95% CI, 86-96%) met criteria for an acceptable dosage given. The most common appropriate indication given was stress ulcer prophylaxis in a high-risk setting (13%; 95% CI, 8-21%) with appropriate use of this indication 45% of the time (95% CI, 29-62%). IV PPIs were appropriately prescribed most often by the medical intensive care unit (66.7%; 95% CI, 43-84%) and least often by the surgical wards services (16%; 95% CI, 7-33%). No discernable indication was given in 52% of cases (95% CI, 43-62%), and patients were not actually nil per os in 46% of these instances (95% CI, 34-59%). Conclusions Intravenous PPI prescribing habits in this military hospital facility are poor. A multifaceted approach including physician/pharmacist education, IV PPI ordering templates, and a consensus medical position statement from a major gastroenterological or prominent medical association may lead to more appropriate use.
引用
收藏
页码:1947 / 1952
页数:6
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