Inappropriate use of proton pump inhibitors among medical inpatients: a questionnaire-based observational study

OBJECTIVES: To evaluate the appropriateness of proton pump inhibitor (PPI) prescribing by conducting an audit of medical inpatients against recommended guidelines. DESIGN: Questionnaire-based study. All medical wards were audited and different information was documented by patients' medical records review (both hospital visit notes and general practitioner's letters) and short interview, where we asked them to name the clinical reason for using PPI. SETTING: This study was carried out in the setting of a regional hospital (537-bed, secondary care referral centre) in Ireland. PARTICIPANTS: The study participants were all consecutive medical patients admitted to the medical wards at Waterford Regional Hospital, Waterford. MAIN OUTCOME MEASURES: The appropriateness of PPI usage in our regional hospital by assessing the level of its prescribing against published guidelines (NICE, 2000). RESULTS: During the audit period, 205 consecutive medical inpatients were assessed. Seventy-nine percent (162 out of 205) of the studied patients were found to be using PPI. For 45% (n = 73) of patients, there was no documentation of valid indication for being on PPI. Overall, 64% of patients were prescribed PPI by hospital doctors, either during their current or previous admissions. We noted that 31% (n = 51) of patients were taking PPI for ≥2 years and another 25% of patients were using PPI for about one year. Only 12% (n = 20) of patients had undergone endoscopy procedures. CONCLUSION: Inappropriate use of PPI remains common in hospital practice. The risks of using long-term PPI must be weighed against the benefits.