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

Abstract

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.