A Structured Protocol to Optimize Proton Pump Inhibitor Use: A Quality Improvement Initiative

BACKGROUND: Proton pump inhibitors are widely used to treat gastrointestinal conditions, but prolonged use increases the risk of infections, fractures, kidney disease, and other adverse outcomes, particularly in adults aged 65 years and older. Despite guideline recommendations for limited duration, inappropriate prescribing remains common, contributing to adverse outcomes and increased health care costs. LOCAL PROBLEM: Baseline audits at a 24-bed telemetry unit in a Texas community hospital revealed that 35.3% of older adults were prescribed proton pump inhibitors without appropriate indication. The purpose of this initiative was to evaluate the effect of a nurse-led proton pump inhibitor medication review using a structured proton pump inhibitor deprescribing algorithm. METHODS: This 16-week quality improvement initiative, guided by the Iowa Model of Evidence-Based Practice, included an 8-week preimplementation phase followed by an 8-week postimplementation assessment phase. Forty-five nurses were trained to apply the deprescribing algorithm in collaboration with physicians and pharmacists at patient admission and discharge. Implementation tools included electronic health record text templates, patient education resources, and interprofessional huddles. RESULTS: Among 186 patient records reviewed, inappropriate proton pump inhibitor use declined from 35% to 5% (P < .001). No adverse gastrointestinal events were reported. Informal feedback showed increased nurse confidence in and knowledge of deprescribing practices. CONCLUSIONS: This nurse-led intervention significantly reduced inappropriate proton pump inhibitor prescriptions and enhanced patient safety. Integration of decision tools, education, and interprofessional collaboration supported sustainability. The model is scalable to other medication stewardship efforts in acute care.