Audit of IV pantoprazole: pattern of administration and compliance with guideline in a teaching hospital

BACKGROUND Drug use evaluation is a performance improvement method that evaluates medication-use processes. Medication studies are especially important for drugs with narrow therapeutic index, specific indication, high costs as well as for drugs with widespread use. Intravenous pantoprazole always ranked among the top 5 costly drugs in Amir-al-Momenin Hospital. Considering the fact that widespread and inappropriate use of this drug is considered as a concern in hospitals all over the world rather than being a regional problem, we decided to establish a guideline for intravenous (IV) pantoprazole in our hospital and evaluated the pattern of its administration both before and after establishing the guideline. METHODS This is an experimental study (clinical trial) performed at the Amir-al-Momenin Hospital, on 400 randomly selected patients receiving IV pantoprazole (bolus or infusion) during a 6-month period (3 months before and 3 months after establishing guideline). We used predesigned data collection forms to collect related information. We used SPSS Ver. 18 for statistical analysis. RESULTS Our results showed that the established guideline could significantly reduce the rate (P = 0.00) and cost (301,289,000 Rials or 8608 USD in 3 months study period after establishing guideline) of IV pantoprazole administration, but failed to rectify indications and dosage of its administration at the same rate. Stress ulcer prophylaxis was the most frequent approved indication for IV pantoprazole administration in our study population. We also observed that the rate of commitment to the guideline decreased by the time passed from its establishment. CONCLUSION We concluded that although establishing guideline was successful in reducing the overall rate of IV pantoprazole administration and its related costs, different contributing factors halted its effect on correcting the prescribed dosage and indications, especially as the time gaps from guideline establishment. This fact magnifies the importance of continuous educations of prescribers about the importance of evidence based practice and need for and implementing a powerful executive supervisory in our hospital.