2026 Eastern States Conference

Title: Evaluation of proton pump inhibitors on discharge list without a documented indication at a community hospital

Authors: Brooke Wagner, PharmD; Kevin Dilley, PharmD; Matthew Montavon, PharmD

Objective: Identify clinician-centered barriers to de-prescribing proton pump inhibitors (PPIs) at hospital discharge.

Self-assessment Question: True or False: A patient who was taking a proton pump inhibitor prior to admission should automatically be continued on the same therapy at discharge.

Background: To evaluate the incidence of PPIs at hospital discharge without an appropriate indication.

Methods: This single-center retrospective medication use evaluation included adults 18 years and older who were discharged on a proton pump inhibitor (PPI) from Southern Ohio Medical Center over a one-month period (February 1, 2026 through February 28, 2026) identified through manual chart review of electronic health record reports to assess the appropriateness of the documented indication. The primary outcome was the proportion of patients discharged on a PPI without a documented indication, defined by established criteria; secondary outcomes included duration of therapy and inpatient initiation. Descriptive statistics were used for analysis.

Results: A total of 404 encounters were reviewed during the study period. Of these, 399 patients (98.8%) were discharged on a PPI and included in the primary analysis. 5 patients (1.2%) were not discharged on a PPI. Among the 399 patients discharged on a PPI, 339 (85%) had an appropriately documented indication. The primary outcome showed that 60 patients (15%) were discharged on a PPI without an appropriate documented indication. The appropriate duration of therapy was documented in 27 of 399 patients (6.8%). The remaining 372 patients (93.2%) had an inappropriate or unclear discharge therapy duration. PPI therapy was newly initiated during hospitalization in 4 of 399 patients (1%). Most patients discharged on a PPI were continued on therapy present before admission, accounting for 395 of 399 (99%). The most common PPI agents prescribed at discharge were pantoprazole and omeprazole. Pantoprazole accounted for 220 of 399 PPI discharges (55.1%), and omeprazole accounted for 131 of 399 discharged patients (32.8%).

Conclusions: In this medication use evaluation, 15% of patients discharged on a PPI did not have an appropriate documented indication. Only 1% of patients were newly initiated on PPI therapy during hospitalization and continued after discharge, indicating that most discharge PPI prescribing reflected continuation of pre-admission therapy. These findings suggest that pharmacist-led discharge stewardship should focus on reassessing chronic outpatient PPI therapy, clarifying the indication, and documenting the intended duration when continued therapy is appropriate.