Use of Proton Pump Inhibitors and Other Acid Suppressive Medications in Newly Admitted Nursing Facility Patients

Introduction

Many patients are not only prescribed proton pump inhibitors (PPIs) or other acid-suppressive medications (ASMs) during their hospital stay, but are discharged to the nursing facility on these medications. We wanted to quantify the amount of acid-suppressive prescription in new admissions, and how many patients had diagnoses that would justify their use.

Methods

A chart review of 98 admissions to a 128-bed for-profit nursing facility in Pennsylvania was performed to assess how many patients were transferred on a PPI or H₂ blocker. Data were collected on age, sex, and any diagnoses relevant to the prescription of a PPI.

Results

Sixty (61%) of 98 patients had a PPI on their transfer orders to the skilled nursing facility (SNF). An additional 3 patients were on an H₂ receptor antagonist, totaling 64.3% prescribed acid suppression therapy. Only 30 patients (50%) had an appropriate diagnosis in their medical record justifying prescription of an ASM based on our criteria. In addition, 3 (3.1%) of 98 patients had a qualifying diagnosis in their medical records, but were not on PPI or H₂ receptor antagonists on admission to the SNF.

Conclusion

Many patients admitted to an SNF may be prescribed acid-suppressive therapy with no clear indication. Inappropriate use of PPI therapy should be minimized as overuse will not only increase drug costs, but also the risks of drug side effects and polypharmacy.

Keywords: Proton pump inhibitors, acid-suppressive medications, nursing facility, geriatric patients