Physicians’ Compliance With Order Entry Forms for Intravenous Pantoprazole in a Tertiary Care Hospital
The widespread inappropriate use of intravenous (IV) pantoprazole, due to its high cost, is a substantial issue. To improve its rational use, an order entry form (OEF) based on the institutional guideline, was implemented. Physicians were required to fill an OEF upon administration of IV pantoprazole. We aimed to evaluate the compliance of physicians as well as the accuracy of filled OEFs six months after the implementation. The study was conducted in a tertiary care teaching hospital in Tehran. Chart review was performed for all patients with an IV pantoprazole order. IV pantoprazole OEFs received by the hospital pharmacy for these patients were evaluated in terms of quantity and quality (e.g., completeness, accuracy of filled items, etc.). Only for 270 (62%) patients, OEFs were received by the hospital pharmacy. Indications were specified in 199 (73.5%) forms, and their agreement with the forms filled by the researcher was 37.8%. The most frequent indication specified in OEFs was stress ulcer prophylaxis (40.7%). IV pantoprazole administration was rational only in 15.9% of cases. The emergency ward had the highest frequency of orders (57.9%), while having the lowest fill rate (56.7%) among the wards with the highest number of orders. The disagreement between the researcher and the OEFs regarding the need for IV medication was 39.5%. This study demonstrated that the compliance of physicians with the accurate completion of OEFs was suboptimal. It seems that for long-lasting changes in IV pantoprazole utilization patterns, barriers should be determined, and additional methods such as ongoing educational seminars or feedback might be needed along with OEF.
1. Eslami L, Nasseri-Moghaddam S. Meta-analyses: does long-term PPI use increase the risk of gastric premalignant lesions? Arch Iran Med. 2013;16(8).
2. Lanas A. We are using too many PPIs, and we need to stop: a European perspective. Am J Gastroenterol. 2016;111(8):1085.
3. Savarino V, Dulbecco P, de Bortoli N, et al. The appropriate use of proton pump inhibitors (PPIs): need for a reappraisal. Eur J Intern Med. 2017;37:19-24.
4. Lin D, Eke C, Cai C, et al. Decreasing overall and inappropriate Proton Pump Inhibitor use: perspective from a large safety-net healthcare system. Clin Gastroenterol Hepatol. 2020;18(4):763-766. e762.
5. dos Santos YdAP, Younes-Ibrahim MS, Crozatti LL, et al. Adherence to a stress ulcer prophylaxis protocol by critically ill patients: a prospective cohort study. Rev Bras Ter Intensiva. 2020;32(1):37.
6. Rafinazari N, Abbasi S, Farsaei S, et al. Adherence to stress-related mucosal damage prophylaxis guideline in patients admitted to the intensive care unit. J Res Pharm Pract. 2016;5(3):186.
7. Foroughinia F, Madhooshi M. Attachment to stress ulcer prophylaxis guideline in the neurology wards of two teaching and non-teaching hospitals: A retrospective survey in Iran. J Res Pharm Pract. 2016;5(2):138.
8. Lai PSM, Wong YY, Low YC, et al. Unexplained abdominal pain as a driver for inappropriate therapeutics: an audit on the use of intravenous proton pump inhibitors. PeerJ. 2014;2:e451.
9. Huang H-B, Jiang W, Wang C-Y, et al. Stress ulcer prophylaxis in intensive care unit patients receiving enteral nutrition: a systematic review and meta-analysis. Crit Care. 2018;22(1):20.
10. Krag M, Marker S, Perner A, et al. Pantoprazole in Patients at Risk for Gastrointestinal Bleeding in the ICU. N Engl J Med. 2018.
11. Sohrevardi S-M, Vahidi A, Mosadegh M-H, et al. Evaluation of Prescriptions and Use of Intravenous Pantoprazole in General Wards and Intensive Care Unit of Shahid Sadoughi Hospital in Yazd. Journal of Pharmaceutical Care. 2016;3(1-2):7-10.
12. Moradi M, Raeesi S, Sepehri Z. Audit of IV pantoprazole: pattern of administration and compliance with guideline in a teaching hospital. SpringerPlus. 2016;5(1):1749.
13. Tringali A, Manta R, Sica M, et al. Comparing intravenous and oral proton pump inhibitor therapy for bleeding peptic ulcers following endoscopic management: a systematic review and meta‐analysis. Br J Clin Pharmacol. 2017;83(8):1619-1635.
14. Bajaj JS, Dua KS, Hanson K, Presberg K. Prospective, randomized trial comparing effect of oral versus intravenous pantoprazole on rebleeding after nonvariceal upper gastrointestinal bleeding: a pilot study. Dig Dis Sci. 2007;52(9):2190-2194.
15. Foroutan N, Fahimi F, Dabin Y, et al. Budget Impact Analysis of Using Omeprazole Immediate-Release Oral Suspension in Replace of Intravenous Pantoprazole in Critically Ill Patients. J Popul Ther Clin Pharmacol. 2015;22(3).
16. Lau BD, Pinto BL, Thiemann DR, Lehmann CU. Budget impact analysis of conversion from intravenous to oral medication when clinically eligible for oral intake. Clin Ther. 2011;33(11):1792-1796.
17. Hogerzeil HV. Promoting rational prescribing: an international perspective. Br J Clin Pharmacol. 1995;39(1):1-6.
18. Laing R, Hogerzeil H, Ross-Degnan D. Ten recommendations to improve use of medicines in developing countries. Health Policy Plan. 2001;16(1):13-20.
19. Taghizadeh-Ghehi M. Professional Interventions to Improve Rational Prescribing and Drug Utilization: Role of Pharmacists. Journal of Pharmaceutical Care. 2018;6(3-4):37-38.
20. Walker MJ, Crews NR, El-Halabi M, Fayad NF. Educational Intervention Improves Proton Pump Inhibitor Stewardship in Outpatient Gastroenterology Clinics. Gastroenterology Res. 2019;12(6):305.
21. McDonald EG, Jones J, Green L, et al. Reduction of inappropriate exit prescriptions for proton pump inhibitors: A before‐after study using education paired with a web‐based quality‐improvement tool. J Hosp Med. 2015;10(5):281-286.
22. Walton SM, Galanter W, Rosencranz H, et al. A trial of inpatient indication based prescribing during computerized order entry with medications commonly used off-label. Appl Clin Inform. 2011;2(01):94-103.
23. Del Giorno R, Ceschi A, Pironi M, et al. Multifaceted intervention to curb in-hospital over-prescription of proton pump inhibitors: A longitudinal multicenter quasi-experimental before-and-after study. Eur J Intern Med. 2018;50:52-59.
24. Salmasian H. Identifying and reducing inappropriate use of medications using Electronic Health Records: Columbia University; 2015.
25. Laki B, Taghizadeh‐Ghehi M, Assarian M, et al. Effect of hospital‐wide interventions to optimize albumin use in a tertiary hospital. J Clin Pharm Ther. 2017; 42(6):704-709.
26. Thompson W, Hogel M, Li Y, et al. Effect of a proton pump inhibitor deprescribing guideline on drug usage and costs in long-term care. J Am Med Dir Assoc. 2016;17(7):673. e671-673. e674.
27. Søndergaard J, Hansen DG, Rowett D. Interventions which influence prescribing decisions and drug utilization. Drug Utilization Research: Methods and Applications: Wiley-Blackwell; 2016.
28. Sirinavin S, Suvanakoot P, Sathapatayavongs B, Malatham K. Effect of antibiotic order form guiding national use of expensive drugs on cost containment. Southeast Asian J Trop Med Public Health.1998; 29:636-642.
29. Cyriac JM, James E. Switch over from intravenous to oral therapy: A concise overview. J Pharmacol Pharmacother. 2014;5(2):83.
30. Valizadeh Toosi M, Elahi Vahed AR, Iradj Maleki I, Bari Z. Comparison of Oral versus Intravenous Proton Pump Inhibitors in Preventing Re-bleeding from Peptic Ulcer after Successful Endoscopic Therapy. Middle East J Dig Dis. 2018; 10(4): 236-241.
|Issue||Vol 61 No 6 (2023)|
|Order entry form Medication request form Order entry sheet Pantoprazole Proton pump inhibitor Stress ulcer prophylaxis Gastrointestinal bleeding|
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