# Improving patient safety by promoting guideline-concordant Proton Pump Inhibitor Use

> **NIH VA I21** · WM S. MIDDLETON MEMORIAL VETERANS HOSP · 2020 · —

## Abstract

Background: Three out of every five prescriptions for proton pump inhibitors (PPIs) in hospitalized non-ICU
patients are not guideline concordant. These stomach acid suppressing medications have been associated
with a 25% increase in mortality risk and cost the US healthcare system over 11 billion dollars annually. Initially
perceived to be harmless, evidence is mounting that PPI use is associated with many serious adverse effects
such as Clostridium difficile infection (CDI), pneumonia, bone fractures, reduced serum magnesium, kidney
disease and vitamin B12 deficiency. Professional guidelines define concordant PPI Rx as those prescribed for
the recommended indications within indicated doses and discontinued when the diagnosis no longer exists for
a given patient. PPIs are appropriately prescribed for conditions such as esophageal ulcers, gastric ulcers,
duodenal ulcers, peptic ulcers, gastroduodenal ulcers, Barrett's esophagus and esophageal reflux. There is an
urgent need to develop and test interventions to promote guideline concordant PPI prescription. Because PPIs
increase the risk of CDI and the need for antibiotics to treat CDI, antibiotic stewardship principles may be
applied to PPI stewardship also.
Project Objectives: 1) Develop a PPI de-implementation intervention, assess its effectiveness and
acceptability/feasibility of integrating it into an existing antibiotic stewardship program. 2) Evaluate the fidelity to
the intervention by providers who include physicians, nurse practitioners, and physician assistants. Data
generated will inform the design and conduct of a future multisite study.
Project Methods: We will use the Systems Engineering Initiative for Patient Safety (SEIPS 2.0) model to
develop and evaluate the intervention. The intervention will be housed in the existing antibiotic stewardship
program. It will involve a medication reconciliation approach in which, using the electronic medical record, a
pharmacist team member will send a PPI stewardship recommendation to the provider to discontinue PPI use
or switch an alternative medication. We will make adaptations and changes to the intervention as we get
feedback from the antibiotic stewardship team, providers, and patients. We will measure the proportion of
patients receiving guideline concordant PPI in the pre-and post-intervention period. We will measure
acceptability by post-intervention focus group interviews with stakeholders, including patients. We will assess
intervention fidelity using a five component tool developed the Dane and Schneider. We will adapt the tool to
assess the five components of exposure to the intervention, quality of delivery of the intervention, participant
responsiveness to the intervention, intervention differentiation and adherence to the intervention. For example,
we will query participants regarding the extent to which intervention components reached them (exposure), if
communications to discontinue or continue PPI were effective (quality of de...

## Key facts

- **NIH application ID:** 10125814
- **Project number:** 5I21HX002618-02
- **Recipient organization:** WM S. MIDDLETON MEMORIAL VETERANS HOSP
- **Principal Investigator:** Jackson Ssentalo Musuuza
- **Activity code:** I21 (R01, R21, SBIR, etc.)
- **Funding institute:** VA
- **Fiscal year:** 2020
- **Award amount:** —
- **Award type:** 5
- **Project period:** 2019-01-01 → 2020-09-30

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10125814

## Citation

> US National Institutes of Health, RePORTER application 10125814, Improving patient safety by promoting guideline-concordant Proton Pump Inhibitor Use (5I21HX002618-02). Retrieved via AI Analytics 2026-05-23 from https://api.ai-analytics.org/grant/nih/10125814. Licensed CC0.

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