(1281) Pump the Brakes: Decreasing Inappropriate Continuation of PPIs Post-Stress Ulcer Prophylaxis

Introduction: Proton pump inhibitors (PPIs) are used for gastroesophageal reflux disease, gastrointestinal bleeds, and for stress ulcer prophylaxis in patients on vasopressors or high dose steroids. While PPIs are indicated, they are not without side effects. Long term consequences include osteoporosis, increased risk of infections such as spontaneous bacterial peritonitis, pneumonia, and Clostridium difficile, decreased nutrient absorption (iron, vitamin B12), and dementia. We hypothesize that many patients started on a PPI for stress ulcer prophylaxis during ICU stays will be transferred to the general ward without proper medication reconciliation.
We aim to investigate the inappropriate continuation of PPIs in patients transferred out of the medical ICU with a goal to decrease these occurrences.

Methods: Inclusion criteria was defined as patients that were admitted to the medical ICU in the past 6 months that were transferred/discharged on pantoprazole. A report was generated comparing the number of patients that were on it prior to admission versus the number of patients that had pantoprazole ordered during admission.

Results: In these 6 months, 2525 patients were admitted to the ICU. Of these, 1545 received pantoprazole during admission. When the patient population was examined using the methods above, 411 of these patients had pantoprazole listed as a home medication.

Conclusions: Of these patients, 1134 were not on a PPI at home, but were on them at time of transfer from the ICU. While the exact effects of these drugs cannot be obtained from this data set, the volume suggests a noteworthy potential for adverse events.
Future data collection will include chart review of reason for initiation of PPI, reason for continuation, whether patients were discharged with a PPI as a new medication, and vital status at discharge. Side effects directly attributed to PPI use will be investigated.
We aim to create and implement an EMR prompt. This tool would prompt the user to consider whether continuation of PPI is needed at transfer. We would then assess if there was a decrease in continuation of PPIs.
We find it necessary to carefully consider reconciliation of PPIs as they pose risk for potentially harmful side effects and adverse events. We hope that this project will decrease PPI use when no longer required.