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feasibility of a PPI stewardship program which can be initiated during hospitalizations to target both inpatient and outpatient PPI overuse. The pharmacists performing the daily
review found that this task typically takes between 15 and 45
minutes to perform, which is a reasonable addition to a daily
workload, although this time frame may vary between facilities, depending on the number of patients to be reviewed
every day. Sites could also consider training pharmacy residents or students to assist with the initial screening, which
may further decrease the pharmacist resources required for
this project. Similarly, this program could be modified by
pharmacists working in an ambulatory setting to screen
patients for appropriate PPI indications during their clinic
visits, and collaborative care agreements could be established with their providers to implement a similar program.
Potential avenues for continued research include the further assessment of risk factors which may contribute to
patients' inability to tolerate PPI discontinuation.
Comorbidities such as depression and tobacco dependence
have been suggested as barriers to successful PPI discontinuation; however, our sample size was too small to allow an
evaluation of these risk factors.37,38 Further research may
allow practitioners to better stratify patients according to
their likelihood for successful PPI discontinuation and tailor
their discontinuation strategy accordingly (for instance,
choosing a PPI taper in high-risk patients, versus "as needed"
antacids in lower risk patients).

Conclusion
A PPI stewardship program at our institution resulted in successful reduction of inappropriate PPI use both in the inpatient and outpatient settings. Complications from the program
appear minimal.
Acknowledgments
This material is the result of work supported with resources and the
use of facilities at the Lexington VA medical facility. The contents
of this article do not represent the views of the US Department of
Veterans Affairs or the United States Government.

Declaration of Conflicting Interests
The author(s) declared no potential conflicts of interest with respect
to the research, authorship, and/or publication of this article.

Funding
The author(s) received no financial support for the research, authorship, and/or publication of this article.

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Table of Contents for the Digital Edition of Hospital Pharmacy - February 2018