Improving Appropriateness of Acid-Suppressive Medication Use via Computerized Clinical Decision Support
This is a review for SJ Herzig’s Improving Appropriateness of Acid-Suppressive Medication Use via Computerized Clinical Decision Support. 
Data shows that up to 70% of acid-suppressive medication (ASM) use in hospitals is not indicated, most commonly for stress ulcer prophylaxis outside the ICU. The computerized clinical decision support (CDS) intervention was designed with the goal to reduce the inappropriate use of ASM for stress ulcer prophylaxis in hospitalized patients.
A quasi-experimental study using an interrupted time series to analyze data collected prospectively during clinical care before and after implementation of the study intervention.
Patients and Setting
All patients above 18 years of age admitted to a 649-bed academic medical center in Boston, MA between September 12, 2011 and July 3, 2012 were included. The hospital had both an East and West campus.
The purpose of the first phase was to obtain baseline data on ASM use prior to implementation of the CDS tool. During the baseline phase, a computerized prompt was activated through the hospital’s POE system whenever a clinician initiated an order for ASM, asking the clinician to select the reason/reasons for the order based on a predefined response. There were seven options provided to choose from.
In the second phase of the study, if a clinician selected stress under prophylaxis as the only indication for ordering ASM, a CDS prompt alerted the clinician that “Stress ulcer prophylaxis is not recommended for patients outside of the ICU. The clinician could then select either, “For use in ICU-Order Medication,” “Choose Other Indication,” or “Cancel Order.”
The primary outcome was the rate of ASM use with stress ulcer prophylaxis selected as the only indication in a patient located outside the ICU. Patient location was confirmed in the 24 hours after the order was placed. Secondary outcomes were rates of overall ASM use, defined via pharmacy charges, and rate use on discharge.
There were 26,400 adult admissions during the study period, and 22,330 discrete orders for ASM. Overall, 46% of admissions had at least 1 charge for ASM. The primary indication for use of ASM in the patient population was continuing pre-admission medication. Stress ulcer prophylaxis was the third most cited reason for ASM prescribing.
In this single-center study, it was found that a computerized CDS intervention resulted in a significant reduction in use of ASM for the sole purpose of stress ulcer prophylaxis in patients outside the ICU, a non-significant reduction in overall use, and no change in use on discharge. Although overall rates of ASM use declined after the intervention, the change was not statistically significant, and was not of the same magnitude as the decline in rates of use for the purpose of stress ulcer prophylaxis.
The simple computerized CDS intervention was associated with a reduction in ASM use for stress ulcer prophylaxis in patients outside the ICU, a non-significant reduction in overall use, and no change in the use on discharge.
- Herzig, SJ et al. Improving Appropriateness of Acid-Suppressive Medication Use via Computerized Clinical Decision Support. Journal of Hospital Medicine. 2015:10:41-45. http://onlinelibrary.wiley.com.ezproxyhost.library.tmc.edu/doi/10.1002/jhm.2260/epdf