2996 Proton Pump Inhibitors: Do We Practice What We Preach? A Quality Improvement Intervention

Abstract

INTRODUCTION: Timing in the administration of proton pump inhibitors (PPIs) plays an important role in their efficacy. Studies have demonstrated increased efficacy of PPIs when administered 30-60 minutes before the first meal of the day. Current default frequency for PPI orders at our urban community hospital is “daily,” which translates to a 10 am administration. This quality improvement study investigates the frequency with which PPIs are being ordered, and if they are being done in line with current recommendations. METHODS: The Plan-Do-Study-Act (PDSA) model was applied in order to determine whether there was a problem in PPI administration frequencies, and if so, how to address that problem. A retrospective and prospective electronic medical record (EMR) analysis was done. Data retrieved from that analysis included whether or not a PPI was ordered, which service it was ordered by, and the frequency at which it was ordered. Inclusion criteria included any inpatient in the hospital who had a PPI ordered. Exclusion criteria included any patient that was not an inpatient, did not have any PPI ordered, had a PPI ordered for more than once a day or had a PPI drip ordered. Statistical analysis was done with percentage change from baseline results. RESULTS: During a one month period (December 2018), every inpatient had a PPI frequency of daily. This meant the PPI would be given at 10 am. Based on the data, an EMR intervention was implemented where the default frequency for PPI administration was changed from “daily” to “before breakfast,” which meant it would be given at least 30 minutes before breakfast. A second report was run after the intervention for a one month period (March 2019), and it was noted that every single inpatient PPI ordered now had a frequency of “before breakfast.” This was a 100% improvement from the baseline. CONCLUSION: Quality improvement is not only important in improving healthcare systems but also in improving patient care. The PDSA model was applied here in order to correct an overlooked issue within our urban community hospital. Once the problem was identified, a simple EMR intervention was implemented. This change created 100% compliance with current recommendations, which led to improved patient care while not creating more work for the housestaff.