065 Assessing the use of proton pump inhibitors in a surgical unit

Background and Objectives Many studies have indicated that prescriptions for proton pump inhibitors (PPI) for preventing ulcer stress or nonsteroidal antiinflammatory drugs (NSAIDs)-related gastralgia in France often do not comply with the guidelines of the French Health Products Safety Agency (AFSSAPS). We carried out a prospective study on the impact of a quality improvement programme on PPI use in our orthopaedic surgery department. Programme With the consent of our hospital9s medical committee, a protocol for oral and intravenous PPI use during the perioperative period was drawn up by anaesthesiologists in collaboration with several departments (gastroenterology, pharmacology, pharmacy) and was validated by all members of our care team. The protocol followed recent AFSSAPS guidelines. PPI prescription was only permitted when one or more risk factors had been clearly identified. The use of NSAIDs for postoperative analgesia was limited to three consecutive days, except under special circumstances. Oral administration was the preferred route of PPI administration. Monthly PPI consumption and severe gastric complications (need for endoscopy) were analysed and compared with data for the previous year. 10 months after the introduction of the protocol, 20 medical records were randomly selected. The conformity of prescriptions with guidelines and compliance by nurses were analysed by a pharmacist not involved in the study. Data are expressed in defined daily dose (DDD) and presented as mean±SD. Results There was a significant 35.5% decrease in oral PPI consumption which fell from 901±211 DDD before the introduction of the protocol to 581±235 DDD 1 year after protocol introduction (p Discussion and Conclusion Our study has confirmed the value of professional practice evaluation protocols to improve patient care. The introduction of a protocol based on the identification of clear risk factors before PPI prescription helped reduce overall PPI consumption without increasing the incidence of gastric complications. This reduction should be associated with a decrease in side effects, drug interactions, and costs. However, high involvement of all staff members is needed to achieve these results. Contexte, Objectifs De nombreux travaux ont souligne la frequence des derives entre la prescription des inhibiteurs de la pompe a protons (IPP) dans la prevention de l9ulcere de stress ou des gastralgies sous AINS, et les recommandations de l9AFSSAPS. De telles derives ont ete constatees dans notre etablissement. A partir de ces constatations, nous avons mis en place une Evaluation des Pratiques Professionnelles (EPP) visant a ameliorer la qualite des prescriptions de ces medicaments dans le service de chirurgie orthopedique. Programme Apres accord de la commission EPP de notre etablissement, un protocole de prescription des IPP oraux et intraveineux, elabore a partir des recommandations de l9AFSSAPS et en concertation avec les services de gastrologie, de pharmarcologie et la pharmacie, a ete presente et valide par l9ensemble du personnel medical et paramedical du service. La prescription d9IPP necessitait la presence de facteurs de risque identifies et l9utilisation d9AINS dans le cadre de l9analgesie postoperatoire etait limitee a 3 jours consecutifs, sauf prescription contraire. La voie orale etait privilegiee en premiere intention pour les IPP. La consommation mensuelle des IPP et l9incidence d9effets indesirables graves digestifs (recours a l9endoscopie) etaient analysees et comparees a l9annee precedant la mise en place de l9EPP. Dix mois apres le debut, 20 dossiers tires au sort etaient analyses par une personne exterieure au service, afin de verifier la pertinence des prescriptions par rapport au protocole. Les donnees sont exprimees en dose journaliere delivree (DDD). Les resultats sont exprimes en moyenne ± DS. Resultats Un an apres la mise en place de l9EPP, la consommation orale des IPP dans le service a diminue de 35,5% (901 ± 211 vs 581 ± 235 DDD, avant vs apres debut EPP, p Discussion Ce travail confirme l9interet des EPP pour l9amelioration du service rendu au patient. En effet, la mise en route d9un protocole base sur des criteres precis a permis de diminuer les consommations d9IPP (diminution des couts, des effets indesirables et des interactions medicamenteuses), sans augmenter l9incidence d9effets indesirables. Une implication de l9ensemble du personnel soignant est cependant indispensable pour atteindre de tels resultats.