Adalberto Gonzalez, MD1, Michael Castillo, MD2, Hans Koop, MD1, Jacqueline Cortizo, MD1, Jodi Chin, MD1, Zaimat Beiro, MD1, Kristen Hagar, MD1
1Cleveland Clinic, Weston, FL; 2Cleveland Clinic Foundation, Miami, FL
Introduction: Proton pump inhibitors (PPIs) are one of the most widely used classes of drugs prescribed in the ambulatory setting. This leads to significant healthcare utilization, as $7 billion was spent in 2009. We performed a quality improvement (QI) project to improve the reconciliation and management of PPIs.
Methods: We performed a QI project form January to May 2019. We began by providing education to our resident physicians and clinic nurses regarding guidelines on appropriate PPI management. We constructed a dot phrase in our electronic medical record meant as a decision tool for physicians (Figure 1). From February to May 2019, we performed the intervention. We included all patients on PPIs seen in the ambulatory clinic by our group of six resident physicians from February to May 2019. Nurses were instructed to point out to physicians if patients were on PPIs after rooming the patient. During the time of medication reconciliation, physicians used the decision tree to make a decision to continue, increase, wean off, or discontinue their patient’s PPI. Next, we collected data for our predetermined variables. We used descriptive statistics to analyze our data.
Results: Our group of physicians saw 558 patients in clinic during our study period. 100 patients were on PPIs. 45 patients (45%) were included in our data analysis; the remaining 55 patients did not undergo reconciliation or documentation of their PPIs. Only 8 patients (17.8%) had their PPIs reconciled in the past one year. 10 of 45 patients (22.2%) had an absolute indication for long term PPI use; 10 patients were appropriately continued on standard dose PPI. 26 (57.8%) patients had a relative indication for long term PPI; 12 of 12 symptomatic patients were appropriately continued on PPI and 14 of 14 asymptomatic patients had their PPIs discontinued. 5 (11.1%) patients had no indication for PPI; all 5 had their PPIs appropriately weaned off. 2 patients (4.4%) with a history of peptic ulcer disease were appropriately taken off PPIs since they were not taking daily aspirin or no steroidal anti-inflammatory drugs (NSAIDs). 2 patients on daily NSAIDs were appropriately continued on PPIs due to risk factors. Overall, the decision tool led to correct management in all cases.
Discussion: Despite an active effort to improve PPI reconciliation, less than half of PPIs were addressed. Our decision tree allowed for the accurate management of PPIs in all patients. Future methods should be developed to increase PPI identification and reconciliation.
Citation: Adalberto Gonzalez, MD; Michael Castillo, MD; Hans Koop, MD; Jacqueline Cortizo, MD; Jodi Chin, MD; Zaimat Beiro, MD; Kristen Hagar, MD. P1174 - IMPROVING THE RECONCILIATION AND MANAGEMENT OF PROTON PUMP INHIBITORS: A QUALITY IMPROVEMENT PROJECT. Program No. P1174. ACG 2019 Annual Scientific Meeting Abstracts. San Antonio, Texas: American College of Gastroenterology.