66 The Use of Proton Pump Inhibitors in An Older Population in A Tertiary Hospital: A Patient Safety Issue?

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Abstract Background PPIs form part of the most commonly prescribed medications in Ireland. There has been emerging concern regarding the risks associated with their chronic use. PPI use has been linked with clostridium difficile infection, pneumonia, hypomagnesaemia, nephrotoxicity, hyponatraemia as well as many other GI and non GI pathologies including dementia. Therefore there has been emerging concern regarding their chronic use. The aim of our audit was to identify the spot prevalence and appropriateness of PPI use for gastro-protection in an older population of medical inpatients in accordance with NICE 2014 PPI guidance “Management of dyspepsia in adults in primary care.” Methods We audited the prevalence of PPI use in medically admitted patients aged ≥65 years at our institution and the use of PPIs within this population. Patients' admission proforma, clinical notes, and drug kardex were reviewed. We collected: age, gender, past medical history, drug list, and laboratory results. This data was used to identify the prevalence and appropriateness of PPI use. Results The total number of medically admitted patients aged ≥65 years was 107. 52(48.5%) were prescribed PPIs. Of the 52, only 7(13.4%) had an appropriate indication: Five patients had concomitant prescription of low dose Aspirin ± clopidogrel and a documented history of gastritis/esophagitis/duodenitis. One patient had a hiatus hernia and gastro-esophageal reflux disease. One patient had chronic NSAID use due to arthritis. Subgroup analysis showed 46/52 were prescribed high dose PPI without indication. Conclusions Our audit confirms this showing that almost 50% of patients aged ≥ 65y admitted to our hospital have been prescribed PPIs. Furthermore, PPI prescriptions were only appropriate in 13.4%. In line with recent guidelines, NICE PPI guidance 2014 and AGA Best Practice Guidelines, our data shows there is scope to rationalise PPI use in older people with resultant cost savings and reduction in complications.