Good afternoon,

As mentioned in the huddle yesterday, per P&T approval, pharmacists are now able to discontinue inappropriately prescribed Proton Pump Inhibitors (all dosage forms of pantoprazole and omeprazole) asCOSIGN REQUIRED in adult patients without proper indication for stress ulcer prophylaxis or other appropriate indication as indicated below.

Additionally, Protonix is being removed from several existing Power Plans for situations where stress ulcer prophylaxis is not indicated, in attempt to decrease inappropriate use. A Sentri7 rule has been created to help pharmacists identify patients receiving a PPI on his or her unit(s). As time allows, please screen your patients and discontinue PPIs for those who do not meet criteria.

**Exclusions: PPIs prescribed by GI physicians, home medications, and the criteria listed below.**

Criteria for use as stress ulcer prophylaxis:
   •Mechanical ventilation > 48 hours
   •Coagulopathy (in absence of an anticoagulant)
        •  Platelet count < 50, INR > 1.5, or PTT 2x baseline        
   •Use of 2 antiplatelet agents (Clopidogrel, aspirin, ticagrelor, etc.) 
   •Ulcer or GI bleed in the past year
   •Major trauma
   •Traumatic head injury or spinal cord injury
   •Partial hepatectomy/ hepatic failure 
   •Patients with TWO or more of the following risk factors:
        •Sepsis
        •ICU length of stay > 7 days
        •Occult bleeding > 6 days
        •High dose steroids
             Dexamethasone: 10 mg/day
             Methylprednisolone: 50 mg/day
             Prednisone: 60 mg/day
             Hydrocortisone: 250 mg/day    

      
PPI indications for treatment or maintenance prophylaxis:
   •Gastroesophageal Reflux Disease (GERD)
   •Gastric or duodenal ulcer
   •GI bleed
   •Erosive esophagitis
   •Helicobacter pylori treatment
   •Chronic NSAID therapy
   •Zollinger-Ellison Syndrome
   •Other appropriate maintenance therapy

Please let Nellie McKee or me know if you have any questions or concerns regarding this protocol. 

Thank you for your help in improving patient safety, as well as cost-effectiveness!