Rethinking ranitidine use in hospitals: how the ranitidine recall
exposed a lack of evidence behind standardized hospital order sets
Abstract
ii. Rationale, aims and objectives Fraser Health, a large health
authority, undertook an audit of standardized order sets (SOS) listing
ranitidine due to the Health Canada recall of ranitidine. Our primary
objective was to determine if ranitidine use on SOSs was supported by
the best available evidence, in order to sparingly use ranitidine in the
hospital. ii. Method Two evaluators recorded the indication of
ranitidine on every SOS and a scoping review of systematic review
evidence was conducted in parallel to a comprehensive review of evidence
quality. Clinical practice guideline recommendations were also recorded
in order to make comparisons to systematic review evidence. iii. Results
Twenty-seven SOSs were found. Seven SOSs (26%) clearly indicated the
medical condition ranitidine was being used for. Twenty SOSs (74%) did
not list an indication or had an unclear indication. Six SOSs (22%)
were supported by systematic review evidence: 4 intensive care unit
(ICU) SOSs for stress ulcer prophylaxis, 1 nausea and vomiting of
pregnancy SOS for heartburn, and 1 emergency department SOS for
heartburn iv. Conclusion The SOS ranitidine audit conducted at Fraser
Health has highlighted inconsistencies between institutional prescribing
policies and evidence. Drugs listed on SOSs should be carefully
considered before being used at an institutional level. To aid
prescribers’ decision making, it may also be beneficial to indicate what
the purpose of each drug is on a SOS Our team plans to use this as an
opportunity to revise other ranitidine SOSs to reflect best evidence.
Evaluation of how ranitidine or other drugs were being prescribed from
SOSs is encouraged.