Aim The effectiveness of proton pump inhibitors (PPIs) have been demonstrated. Nevertheless, the choice of PPI that should be used is less absolute. The clinical effectiveness, availability of the formulation, co-morbidities, route of administration and lowest acquisition cost are all considerations that should be accounted for when determining the appropriate therapy. Current Trust guidance recommends lansoprazole capsules and oral dispersible tablets as the first line PPI, unless other indications preclude its use. Other UK hospitals have audited PPI prescribing and their findings highlight that adherence upon deployment was poor.1 2 This audit aims to assess if written outpatient prescriptions are adhering to the guidelines.
Method This study was conducted prospectively in the outpatient pharmacy, between February and March 2019. The defined data collection period was 5 weeks, which included a 1-week pilot study. The accumulation of data involved reviewing all outpatient prescriptions, whereby PPIs were prescribed, noting if the Trust’s guidance on PPI prescribing was being adhered to. Data was collected via a structured pro forma to assess the percentage compliance against the three predetermined standards:
Standard 1 - Is the PPI prescribed appropriate?
Standard 2 - Is there a documented indication for the prescribed PPI?
Standard 3 - Is the dose appropriate for the patient?
Results There were a total of 84 prescriptions received from 13 different specialties. The age range of patients was 1 month to 16 years with a mean (± median) age of 7.66 ± 7 years. The overall compliance with the Trust’s guidelines for standards 1, 2 and 3 were 76%, 88% and 100% respectively. The infant and toddler age group (28 days – 23 months) showed the least compliance in standard 1, the choice of appropriate PPI (63%). The most common indication was gastro oesophageal reflux disease. Paediatric Gastroenterology received the greatest number of prescriptions over the data collection period. 12% of prescriptions did not have a documented indication and the most common PPI prescribed in the outpatient pharmacy was lansoprazole, which accounted for 64 (77%) of the prescriptions.
Conclusion The findings in this study are synonymous to that of other audits conducted in UK hospitals, where compliance with PPI guidelines were explored. Possible factors that could be attributed to the low levels of adherence are problems with implementation, lack of enforcement of the guidelines, patient/guardian preferences and presence of enteral feeding tubes. Clinicians should monitor their prescribing and where applicable, switch patients who are currently on omeprazole suspension, to lansoprazole oral dispersible tablets/capsules. This could lead to significant monetary savings for the Trust.
Derbyshire Joint Area Prescribing Committee. Gastro-oesophageal reflux disease: recognition, diagnosis and management in children and young people. 2015.
Pan Mersey Area Prescribing Committee. Pharmacological management of gastro-oesophageal reflux disease (GORD) in children and young people in primary and secondary care. 2016.
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