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Team Develops Tool to Help Reduce Unnecessary Medications


Qsource’s Team for Innovation in Medication Safety, or TIMES, developed a tool to help healthcare providers take their patients off of unnecessary acid-reducing medications. Called proton pump inhibitors (PPIs), these medications are used for treating stomach problems like ulcers and heartburn.

Good and Bad

According to the National Institute of Diabetes and Digestive and Kidney Disorders (NIDDK), about 20 percent of Americans have occasional to chronic acid reflux and heartburn. PPIs lower the amount of acid your stomach makes and can heal the esophageal lining in most people with acid reflux.

PPIs can be helpful and well-tolerated when taken as directed. However, the long-term use of PPIs is associated with an increased risk of pneumonia and C. difficile infections. The FDA has also issued warnings that PPIs are associated with low magnesium, vitamin B12, iron, and muscle or kidney problems. In addition, PPIs may cause or contribute to side effects such as headache, nausea, diarrhea, rash and interactions with other medications.

Deprescribing to Reduce Harm

The TIMES group is focused on reducing unnecessary medications that can increase adverse events in older adults. Deprescribing is a method to safely decrease an inappropriate medication, while a healthcare professional supervises. The goal is to wisely manage multiple prescriptions and improve the patient’s health.

In July 2017, the group launched the PPI De-escalation Options tool on the Qsource website. The algorithm provides step-by-step guidance providers can use to help their patients reduce unnecessary PPIs and address stomach problems they may have.

“I was excited when I saw the PPI algorithm and I shared it with our Medical Director,” said Marty Carver, director of nursing at a long-term care facility in Kentucky. “Before we started using this approach, about 90 percent of our residents were on PPIs. Now, it’s down to about 30 percent. This is a great tool.”

According to Qsource Clinical Pharmacy Specialist Amanda Ryan, PharmD, BCGP, feedback from the tool has been positive.

“Since we launched the tool in July last year, we have encouraged the TIMES group members to share it in their practices and with their colleagues. Now we are ready for everyone to start using it to improve the health of their patients on PPIs,” said Ryan.

More About the TIMES Group

Qsource, the Quality Innovation Network-Quality Improvement Organization (QIN-QIO) for Alabama, Indiana, Kentucky, Mississippi, and Tennessee, is working to make medication use safer across the region. To facilitate the work, atom convened a medication safety advisory board called TIMES (Team for Innovation in MEdication Safety). The group consists of two or three members from each state. They represent multiple healthcare settings, including home health providers, hospitals, pharmacies, long-term care facilities, as well as patients and families. All members have a passion for medication safety and a desire to improve patient care.



Contact Amanda Ryan, PharmD, BCGP, Clinical Pharmacy Specialist for Qsource at

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