Non-steroidal anti-inflammatory drug prescriptions in hospital inpatients: are we assessing the risks?

Abstract

To determine non-steroidal anti-inflammatory drug (NSAID) prescribing practices in a tertiary referral hospital. A single time-point audit of drug kardexes and clinical notes of n = 388 patients on 2 July 2008 was carried out assessing demographics, gastrointestinal and coronary heart disease risk factors, renal function and co-prescribed medications. Fifty-seven of 388 (14.7%) hospital patients were on NSAIDs. Forty-nine were prescribed NSAID after admission. Nineteen (32.2%) were on regular NSAID (11/19 on PPI) and 38 patients were on PRN NSAID (12/38 on PPI). Seventeen of 49 patients were on other medications associated with gastrointestinal bleeding (10/17 were on PPI). Nineteen patients (33.3%) were >60 years. Eight patients had three or four risk factors for gastrointestinal bleeding; six were on PPI. Thirteen patients had two risks; 7 were on PPI. Six of 19 patients with one risk factor were on PPI. 40.3% had stage 2/3 chronic kidney disease. 35.1% had ischaemic heart disease. NSAIDs and PPIs are often prescribed inappropriately.