987 TACKLING OVERPRESCRIBING; WHAT ABOUT THE HABITUAL OFFENDER, PPI?

Abstract

Abstract Introduction Overprescribing is a serious problem in health systems internationally and can lead to preventable hospital assessments and admissions, even premature deaths1. Proton pump inhibitors (PPIs) are commonly prescribed in older people. They are associated with risk of C difficile infection, hypomagnesemia, osteoporosis, hypergastrinaemia, and are considered falls risk increasing drugs (FRID). Unfortunately, there isn’t a guideline which unifies the various indications of PPIs. Method 303 discharges were screened from 2 acute geriatric wards between 01/10/2020 and 31/12/2020. After exclusions (34 deaths, 5 readmissions), 264 notes were reviewed. Those with a PPI mentioned on their discharge summaries were audited against both NICE dyspepsia guidelines and our hospital trust guidelines (PPI usage in those on co-medications), assessing whether long term use was advocated. Additional information was obtained from our hospital systems including digital health records. Results 153/264(58%) patients had PPIs listed on their discharge summaries. Of those using PPIs, 146 (95%) had polypharmacy and 140(92%) had a CFS ≥5. More PPIs were commenced (18) than discontinued (16). Against NICE dyspepsia guidelines, 46/153(30%) patients did not require long term PPI treatment. 81/153 (53%) patients had a PPI prescribed due to anticoagulation, however, 37/81 (46%) did not fulfil our trust criteria for co-prescription. Conclusion PPI usage is prevalent in older people and often continued without a valid indication which could result in preventable harm in an already vulnerable cohort. There is a need to actively deprescribe PPIs within all healthcare settings. Our findings have been widely shared with our departmental colleagues and other relevant specialties and a guideline on long term use of PPIs in older people (>65) has been developed. Going forward, we plan to re-audit against this new guideline in 6 months to assess improvement.