Date of Award

Spring 5-23-2020

Document Type

Doctor of Nursing Practice Final Manuscript

Degree Name

Doctor of Nursing Practice



First Advisor

Karen Sue Hoyt, PhD, MN


Costly proton pump inhibitors (PPIs) have been widely prescribed since the 1990’s for prevention and treatment of ulcers and gastroesophageal reflux disease (GERD). Evidence published since 2012 demonstrates risks associated with taking PPIs longer than eight weeks. Primary care providers (PCPs) mostly de-prescribe PPIs for persons not meeting criteria for long term use. Many patients resist discontinuation.

A three-month evidenced based practice (EBP) education project was conducted by a nurse practitioner to improve PCP peer de-prescribing successes with appropriate patients in an outpatient California based veteran Primary Care Clinic. Fifteen PCPs were pretested about usual care practices between two comparable clinics. Five PCPs at the smaller clinic location were educated about long term PPI use risks and introduced to three EBP guidelines using tapering techniques with follow up care.

A Canadian 2017 EBP PPI de-prescribing guideline was proposed for translation into practice. PCPs voted to pilot this guideline, dependent upon nursing support. PCPs denied frustration with usual care practices, even as all were willing to try an EBP practice change between pre and post-tests. Support for peer led EBP on site coaching increased from 87% to 100%. Tapering behavior increased from 67% to 100%, expediting improved long-term medication cessation.

Included in

Nursing Commons