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Clinical pharmacy and clinical trials (including case series)
Observing good practice guidelines for proton pump inhibitors in geriatrics units
  1. B. Leroy,
  2. A. Lajoinie,
  3. M. Ducher,
  4. L. Bourguignon
  1. 1Hopital Antoine Charial HCL Pharmacy Francheville, France

Abstract

Background Proton pump inhibitors (PPIs) are a therapeutic class of drugs that are effective for the reduction of gastric acids. Misuse has already been reported in this class of drugs.

Purpose Within the framework of the evaluation of professional practice, The authors performed an audit of the prescription of PPIs in university hospitals.

Materials and methods This multicentre study included three geriatric hospital centres, or approximately 1000 beds, and was performed according to ‘one day study’ methodology. A sample of 20% of all patients taking PPIs was randomly tested. All data on the patient, his/her treatment and disease were recovered from the patient's file. The conformity of the treatment to official guidelines, published by the French National Health Authority (HAS), and its traceability, were verified.

Results 95 medical records were audited. Only 6% of the patients included an appropriate indication and posology. Indications that were not approved in reference documents such as gastrointestinal haemorrhage (10), hiatus hernia (4) or anaemia (2) were described in 21 patients (22%). No indication was found in 59 patients, or 62%. Finally in the 15 patients in which the indication was appropriate, there were errors in length of treatment, posology and the choice of specialities, resulting in non-conforming treatment.

The traceability in the medical record showed that information was insufficient in 100% of the cases. Missing information included the indication (62%) as well as prescription details (length of treatment 95%, posology 50%, and name of the speciality 47%).

Conclusions This audit shows that the main problem is traceability. Because PPI treatment has a satisfactory tolerance profile, it is not the subject of attention by doctors or subject to re-evaluation.

As a result of this study, a computer protocol will be used which is linked to prescription software including all indications validated by official guidelines.

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