Implementation of Guideline-Based Use of Proton Pump Inhibitors for Perioperative Stress Ulcer Prophylaxis: A Pre-Post Study Guided by CFIR-ERIC

Abstract

Xinrui Wang,* Ying Liu,* Yi Zhang, Zhuo Ma, Zhuoling An Department of Pharmacy, Beijing Chaoyang Hospital, Capital Medical University, Beijing, People’s Republic of China*These authors contributed equally to this workCorrespondence: Zhuo Ma, Department of Pharmacy, Beijing Chaoyang Hospital, Capital Medical University, No. 8 Gongren Tiyuchang South Road, Chaoyang District, Beijing, 100020, People’s Republic of China, Tel [phone], Email [email protected] Zhuoling An, Department of Pharmacy, Beijing Chaoyang Hospital, Capital Medical University, No. 8 Gongren Tiyuchang South Road, Chaoyang District, Beijing, 100020, People’s Republic of China, Tel [phone], Email [email protected]: The overuse and misuse of proton pump inhibitors (PPIs) in perioperative patients for stress ulcers prophylactic (SUP) is crucial. This study evaluated the impact of a Consolidated Framework for Implementation Research Expert Recommendations for Implementing Change (CFIR-ERIC)-guided intervention on the rational use of PPIs in a perioperative setting.Methods: A single-center pre-post study was conducted at Beijing Chaoyang Hospital between April and November 2023. All hospitalized patients who used perioperative PPIs for SUP were included. Cases post-intervention were defined as the intervention group and were propensity score-matched with pre-intervention cases, which was defined as the control group. The intervention strategies were developed by following the updated CFIR framework and employing CFIR-ERIC strategies. Outcomes included rational use of PPIs, reasons for irrational use, total hospitalization and drug costs, PPI duration, costs, and average defined daily dose.Results: 1122 cases were included in the intervention group and control group after propensity score matching, respectively. The intervention group showed significant improved rate of rational PPI use (81.7% vs 42.0%, p< 0.001). Rates of non-indication use, inappropriate dosage and administration, drug selection, and administration route were significantly reduced (all p< 0.05). Coagulation disorders or anticoagulant/antiplatelet treatment, severe trauma or multiple injuries, severe infection or sepsis were the three most prevalent severe risk factors among patients, with 46.7% and 29.5% of the two groups, respectively. We found no significant differences between the two groups in total hospitalization costs (¥ 55,672.84 vs ¥ 57,021.73, p=0.621) and total drug costs (¥ 3005.38 vs ¥ 3260.98, p=0.206). Additionally, PPI costs (¥ 7.44 vs ¥ 93.70, p< 0.001) and defined daily dose (7.00 vs 8.00, p< 0.001) were significantly lower in the intervention group. We also observed a downward trend in PPI duration (6.00 days vs 5.00 days, p=0.075).Conclusion: The CFIR-ERIC-guided intervention effectively improved the rational use of PPIs for perioperative SUP, resulting in significant reductions in both the PPI duration and costs.Keywords: proton pump inhibitor, CFIR-ERIC, rational drug use, perioperative medication

Keywords

• proton pump inhibitor
• cfir-eric
• rational drug use
• perioperative medication