Impact of Pharmacy Efforts to Promote the Optimal Use of Ranitidine in a University Teaching Hospital

Abstract

Objective: To determine whether the development, implementation, and outcome of a hospital-wide, pharmacy-initiated, educational and intervention program impacted ranitidine prescribing patterns specific to institution guidelines. Methods: The development of a standardized ranitidine medication utilization guideline (R-MUG) form was established by the departments of pharmacy and gastroenterology in conjunction with the pharmacy and therapeutics committee at the University of California, Irvine. Using this standardized R-MUG form, all hospitalized patients (excluding pediatric, mental health, and labor and delivery) receiving ranitidine during their hospitalization were identified and evaluated for appropriate ranitidine use patterns. A baseline evaluation phase that included 240 patients was conducted, and diagnosis, dosage, and dosage form were recorded. This was followed by an educational program and subsequently a posteducational pharmacist intervention phase involving 210 patients, in which data were collected over a 3-week period. From these data, projected ranitidine cost savings were calculated. Results were used to determine the impact the educational process had on modifying ranitidine prescribing patterns. Results: Initially, ranitidine was prescribed according to the guidelines in 74% of the patients. After educational inservice sessions this number rose to 96% (p < 0.001). The 3-week intervention phase saved approximately $930 compared with the baseline period by limiting the amount of ranitidine used. The optimal choice of ranitidine dosage form increased significantly from baseline (87%) to the posteducational data collection period (94%) (p < 0.01). Targeted intervention of high-need areas of the hospital (surgical and burn intensive care units) resulted in a significant decrease (p < 0.001) in the percentage of inappropriate dosing with continuous ranitidine infusion, but not with intravenous piggyback or syrup. Conclusions: This program was an effective method of educating healthcare professionals regarding ranitidine prescribing, improving the pattern of use of ranitidine, and decreasing costs to the institution. It may serve as a model for addressing other medication usage concerns.