Abstract
BackgroundDrug use evaluation is a performance improvement method that evaluates medication-use processes. Medication studies are especially important for drugs with narrow therapeutic index, specific indication, high costs as well as for drugs with widespread use. Intravenous pantoprazole always ranked among the top 5 costly drugs in Amir-al-Momenin Hospital. Considering the fact that widespread and inappropriate use of this drug is considered as a concern in hospitals all over the world rather than being a regional problem, we decided to establish a guideline for intravenous (IV) pantoprazole in our hospital and evaluated the pattern of its administration both before and after establishing the guideline.MethodsThis is an experimental study (clinical trial) performed at the Amir-al-Momenin Hospital, on 400 randomly selected patients receiving IV pantoprazole (bolus or infusion) during a 6-month period (3 months before and 3 months after establishing guideline). We used predesigned data collection forms to collect related information. We used SPSS Ver. 18 for statistical analysis.ResultsOur results showed that the established guideline could significantly reduce the rate (P = 0.00) and cost (301,289,000 Rials or 8608 USD in 3 months study period after establishing guideline) of IV pantoprazole administration, but failed to rectify indications and dosage of its administration at the same rate. Stress ulcer prophylaxis was the most frequent approved indication for IV pantoprazole administration in our study population. We also observed that the rate of commitment to the guideline decreased by the time passed from its establishment.ConclusionWe concluded that although establishing guideline was successful in reducing the overall rate of IV pantoprazole administration and its related costs, different contributing factors halted its effect on correcting the prescribed dosage and indications, especially as the time gaps from guideline establishment. This fact magnifies the importance of continuous educations of prescribers about the importance of evidence based practice and need for and implementing a powerful executive supervisory in our hospital.
Highlights
Drug use evaluation is a performance improvement method that evaluates medication-use processes
Inappropriate and unsupervised use of IV pantoprazole can lead to unwanted consequences such as increased treatment cost, adverse effects related to injection and increasing the incidence of nosocomial pneumonia, spontaneous bacterial peritonitis (SBP) and Clostridium difficile infections (CDI) (Pang and Graham 2010)
Part 1: Extent of the problem Overall 846 patients were treated with IV pantoprazole during the 3 months period before guideline establishment and 200 cases were randomly selected to include in this study
Summary
Drug use evaluation is a performance improvement method that evaluates medication-use processes. The decision to select an appropriate dosage form depends on several factors; such as patient’s ability to take oral medication, patient’s hemodynamic status as well as intestinal permeability and absorptive capacity (Pang and Graham 2010) These factors often should be considered especially in critically ill patients when pantoprazole is indicated for either treating an acid secreting disorder or prophylaxis of stress related mucosal injury (Pang and Graham 2010). Intravenous pantoprazole was first marketed in Canada in 1999, since it has been used for treatment of different pathological conditions in which rapid reduction of gastric acid is required (Kaplan et al 2005) It is the only IV proton-pump inhibitor commercially available in North America as well as our country, so it is not surprising that this drug is widely used in hospitals. Inappropriate and unsupervised use of IV pantoprazole can lead to unwanted consequences such as increased treatment cost, adverse effects related to injection and increasing the incidence of nosocomial pneumonia, spontaneous bacterial peritonitis (SBP) and Clostridium difficile infections (CDI) (Pang and Graham 2010)
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