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Context Paediatric patients from neonates to 16 years old often require liquid medication formulations for ease of administration via enteral/oral routes. However, many of these are unlicensed or specially prepared, leading to General Practitioner (GP) refusals and consequently initiation on homecare services, increased costs, and added workload for hospital staff – particularly for outpatient repeat prescriptions. A review of trust drug expenditure revealed omeprazole suspension as a significant cost pressure, ranking among the top ten drugs by spend for the financial year 2023/24, despite guidelines recommending lansoprazole as the first-line proton pump inhibitor (PPI). 1 1. To address this, the ‘Omeprazole Challenge’ was launched in August 2024 as a Silver Quality Improvement (QI) project. The initiative aimed to reduce inappropriate omeprazole suspension prescribing, promote guideline adherence, and achieve cost savings.Strategy for Change The strategy began with a pharmacy-led data review to identify prescribing trends and specialties deviating from guidelines. 1 A formal memorandum was distributed to clinical teams, reinforcing restricted indications for omeprazole suspension and promoting lansoprazole as the preferred alternative. Omeprazole suspension was removed from ward stock trust-wide, except on the Neonatal Surgical Ward and Ward 11 (neonatal cardiology), where use remained clinically justified. This stock restriction encouraged prescribers to consider alternatives and enabled pharmacists to challenge prescribing before doses were administered.Further cost mitigation was achieved through price negotiations with suppliers, halving the cost of appropriate omeprazole suspension dispensations. Clinical pharmacy teams supported prescribers with education on PPI prescribing, recommending lansoprazole or omeprazole tablets/capsules where suitable. For patients not meeting suspension criteria, alternative formulations were issued. This reduced reliance on homecare services, which were often required to source unlicensed suspensions following GP refusal.Monitoring and Feedback Post-implementation, prescribing data was monitored to evaluate changes in omeprazole usage. Collaboration with the gastroenterology team ensured guideline reinforcement and clinical appropriateness. The project also enabled a review of the service-level agreement with suppliers, securing a cheaper rate than the licensed product. Over the 2024/25 financial year, the project achieved a £97,000 cost saving and a 54% reduction in omeprazole suspension use.Conclusion In conclusion, this project not only reduced reliance on unlicensed medications but also improved patient experience by offering readily available alternatives and eliminating delays associated with homecare setup following GP refusal. Despite initial success, a resurgence in suspension use highlighted barriers to lansoprazole orodispersible tablet adoption, prompting further guideline review and consideration of administration via feeding tubes.The initiative has since expanded to include collaboration with Birmingham and Solihull Integrated Care System and University Hospitals Birmingham, aiming to standardise care across the region. This QI project demonstrates the impact of targeted interventions, multidisciplinary collaboration, and continuous monitoring in driving cost-effective prescribing practices and improving patient care.Reference Summersby J, Whyte L, Wong T, et al. The use of Proton Pump Inhibitors (PPIs) in the management of gastro-oesophageal reflux disease (GORD) in infants, children and young people. Version 2.1. Local Hospital Guideline (anonymised); 2025.