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

BACKGROUND

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.