TBA (22W124)

An Audit of Proton Pump Inhibitor Prescribing in Patients Attending a Rapid Access Frailty Assessment Unit

Author(s)

Emma McDonnell, Luke Corcoran, Teresa Donnelly

Department(s)/Institutions

Department of Geriatric Medicine, Midland Regional Hospital Tullamore, Co. Offaly

Introduction

PPI usage has revolutionised the treatment of conditions such as Gastro Oesophageal Reflux Disease (GORD), gastric and duodenal ulceration and Barrett’s Oesophagus. However, PPIs are often inappropriately prescribed. PPI use has been linked with electrolyte disturbances, most commonly hypomagnesaemia, resulting in higher rates of osteoporosis. It has also been linked with adverse effects on renal function and increased correlation with clostridium difficile.

Aims/Background

The purpose of this audit was to assess the appropriateness and clinical indication of PPI prescribing among patients attending a Rapid Access Frailty Assessment Unit (RAFAU) in 2022.

Method

A database of patients attending RAFAU in an Irish regional hospital was accessed. Records from years 2021-2022 were searched and documents citing patients’ medical history and clinical indication for prescribed medications included hospital discharge letters, outpatient clinic letters and GP referral letters. NICE guidelines from the UK NHS were used as comparison for prescribing guidelines.

Results

120 patients’ records were assessed. 63 (52.5%) patients were found to be prescribed a PPI among this cohort. Of those taking PPIs, only 15 (23.8%) patients were prescribed a PPI with a documented clinical indication in accordance with NICE Guidelines. Although several patients were taking gastro-erosive drugs including anti-platelets, anticoagulants and steroids, only one patient record mentioned PPIs being prescribed for iatrogenic gastritis. No records mentioned deprescribing or cessation of PPIs.

Conclusions

Most patients prescribed PPIs were without documented appropriate clinical indication and without clear duration of use. Deprescribing medications associated with significant co-morbidities should be prioritised in a frailty population.

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