Implementation of a proton pump inhibitor stewardship program

Abstract

Purpose: The development and implementation of a proton pump inhibitor (PPI) stewardship program at a single institution are described.

Summary: Due to the overuse of PPIs and the increasing awareness of the adverse drug events associated with long-term PPI therapy, the pharmacy and internal medicine services of a medical center implemented a PPI stewardship program. All patients admitted to the internal medicine service were evaluated by the PPI stewardship team to determine if they had an appropriate indication for PPI continuation in the hospital as well as after discharge. If patients did not meet specified criteria for continuation of PPI use during hospitalization, PPI therapy was suspended and replaced by as-needed acid suppressive therapy, and the patients received discharge counseling regarding the implemented medication regimen changes. Challenges encountered during program development included establishing appropriate criteria for PPI continuation and determining the best method for discontinuing PPIs in order to reduce the risk of rebound hyperacidity.

Conclusion: In an effort to reduce unnecessary PPI use, a PPI stewardship program was developed and implemented to ensure appropriate continuation of PPIs for patients admitted and discharged from an internal medicine service.

Keywords: antacids; anti-ulcer agents; gastric acid; gastroesophageal reflux; gastrointestinal tract; proton pump inhibitor.