The benefit of local research: conducting an audit of appropriateness of new proton pump inhibitor prescriptions on discharge

Alice I. Hann

BSc, BPharm (Hons), MPharm | Clinical Pharmacist, The Royal Melbourne Hospital | alice.hann@mh.org.au

[Pharmacy GRIT article no: 20241400, published online 17 April 2024]

There is an increasing trend of proton pump inhibitors (PPIs) prescribing globally, owing to their historical reputation as a safe and effective medication for the management of various gastrointestinal conditions.1,2 Despite the increase in PPI prescribing, the prevalence of conditions requiring PPIs remains relatively stable. However, an increasing body of evidence is suggesting that long-term PPI use is associated with increased risks of a variety of conditions including Clostridium difficile infection, osteoporotic fractures, hypomagnesaemia, pneumonia, and vitamin B12 deficiency.2 These studies have generated global deprescribing efforts targeting PPIs and encourage frequent review of therapy.3

For my residency project, I collaborated with my team leader to form the idea of conducting an audit of PPIs across two of the surgical units at the Royal Melbourne Hospital, where, anecdotally, PPIs are commonly prescribed. Interestingly the literature suggests that surgical units overprescribe PPIs and for indefinite periods of time when compared to medical units.4 Though there is an abundance of studies exploring PPI prescribing and efforts to deprescribe them, it was still useful to our organisation to evaluate the current state of play of our own PPI prescribing.

As this was a snapshot audit, we did not try to account for confounding factors which could affect PPI prescribing. If we were to repeat this study to measure the impact of interventions targeting PPI prescribing, then we would need to consider capturing additional information such as whether the prescription was generated by a doctor or one of our pharmacists through our ‘pended discharges’ workflows. We could then explore the contributing factors to inappropriate PPI prescribing. Application of these results could include creating an educational package that could be delivered to both clinical pharmacists, as well as prescribers to promote appropriate prescribing of PPIs. 

This experience has highlighted the importance of conducting research and audits in the workplace and the role that audits can have in laying the groundwork for future research. Before undertaking this project, I thought research was intimidating and only novel, groundbreaking, research published in journals was important, but now I appreciate the importance of local audits. This audit can now inform the design of future research targeting improving the care provided to our patients. 

Completing this project from start to finish was an invaluable experience. I was able to be involved in the project from its inception, drive the study design and aims of the research, as well as hone my skills in academic writing. Completing this research helped me refine my skills in research, time management, and independent study; skills that will be invaluable for my entire career.

References

  1. Abrahami D, McDonald EG, Schnitzer M, Azoulay L. Trends in prescribing patterns of proton pump inhibitors surrounding new guidelines. Ann Epidemiol 2021; 55: 24–26.
  2. Jaynes M, Kumar AB. The risks of long-term use of proton pump inhibitors: a critical review. Ther Adv Drug Saf 2019; 10: 2042098618809927.
  3. Farrell B, Pottie K, Thompson W, Boghossian T, Pizzola L, Rashid FJ, et al. Deprescribing proton pump inhibitors: evidence-based clinical practice guideline. Can Fam Physician 2017; 63: 354–364.
  4. Luo H, Fan Q, Xiao S, Chen K. Changes in proton pump inhibitor prescribing trend over the past decade and pharmacists' effect on prescribing practice at a tertiary hospital. BMC Health Serv Res 2018; 18: 537.