Increasing the PPI deprescribing rate at a transitional care unit

Abstract

Background: PPIs are overprescribed worldwide, especially among geriatric populations. The long-term use of PPIs is associated with many adverse effects. This project aims to utilize deprescribing algorithms to assist healthcare providers in deprescribing inappropriate PPI prescriptions for patients at a 17-bed transitional care unit within a skilled nursing facility. Methods: The seven-step method problem-solving model was used for this project. Baseline assessment included a review of patient electronic medical records (EMRs) two months before the intervention. Admission and discharge notes were reviewed to identify the baseline rate of patients with PPI prescriptions and the deprescribing PPI rate by discharge. A review of the literature review was conducted to identify interventions that focused on providers deprescribing PPIs. A review of EMRs two months post interventions to identify PPI deprescribing rate. Interventions: Education, including the provision of the deprescribing algorithm, was provided to address the knowledge gap. A post-education survey was completed by providers to identify readiness and motivation levels for deprescribing PPIs. Patient education pamphlets regarding PPIs were made to enhance the success rate for deprescribing PPIs. Education was also provided to nursing staff to help distribute PPI education pamphlets to patients and remind healthcare providers to review PPI prescriptions. Results: Zero healthcare providers responded to the readiness survey. Following the interventions, 5 patients out of 20 on PPIs were deprescribed, compared to 0 out of 11 patients before the interventions. The five patients were deprescribed from PPIs by the same healthcare provider who responded to the follow-up emails after interventions. Conclusions: The project's objectives were not achieved due to healthcare providers' lack of response to the readiness survey, and the deprescription rate was 25% postintervention at TCU compared to the aim of 30%. To improve the chances of success in future QI projects, it is recommended to encourage the participation of healthcare providers and nursing staff through face-to-face education and allow more project time to thoroughly evaluate the impact of chosen interventions.