Reducing C-diff by reducing PPI use

21 Jan 2018

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As many as 60 percent of Salem Hospital inpatients receive a proton pump inhibitor (PPI). The C. difficile team is working to reduce the use of PPIs because:

PPIs substantially increase the risk of C. difficile.
Some of our patients are sent home with PPIs started for stress ulcer prophylaxis.

Assessment and recommendation:

A standard for appropriate PPI use has never existed here. Starting Jan. 30, all PPI orders come with a question asking why this patient needs a PPI. The answers will be buttons showing appropriate uses of PPIs. This information can help you determine:

Is a PPI is appropriate for this patient?
Why did the admitting provider start a PPI (and should I continue it)?

The appropriate uses of PPIs are shown below. Contact Bob Ponec, Jeff Loa, Marty Johnson or Matt Tanner (4-2048 / Matthew.Tanner@SalemHealth.org) with questions.

Appropriate use of PPIs:

Category / Button	Indication / details
Home medication
Symptom-driven use	Heartburn / Dyspepsia / Regurgitation / Epigastric Pain / Nausea / Vomiting
Indication-driven use	Erosive esophagitis / GERD / Zollinger-Ellison syndrome / Peptic ulcer disease / Upper gastrointestinal bleed (proven or suspected) / H. pylori eradication / Barrett’s esophagus
Stress ulcer prophylaxis (SUP)	IMCU or ICU level of care + coagulopathy (INR > 1.5, PTT > 70, platelets < 50, anticoagulant or antiplatelet medication) IMCU or ICU level of care + invasive mechanical ventilation IMCU or ICU level of care + traumatic brain, spinal cord or burn injury or multiple trauma IMCU or ICU level of care + Upper GI bleed / ulcer within 1 year IMCU or ICU level of care + two or more minor risk factors (hypotension, sepsis, high dose glucocorticoids, hepatic failure or transplant, renal failure or transplant)