“Cleaning Up” Intravenous Paracetamol Usage at

Armadale Health Service

Yang Liu, Stephen LimPharmacy Department

Aim

To promote medication safety via the correct use of IV paracetamolTo formulate a policy for IV paracetamol use at AHS

Methods

Randomly selected (n=23) case notes for inpatients who were given IV paracetamol during their stay in AHSReviewed the indication and route of administration Admitted into theatre and EDPeriod of survey: November 2011 to March 2012

Indications for IV paracetamol

• Post- operatively, as an opioid sparing agent, in patients who are nil by mouth and suppositories are contraindicated

• In severe post- operative pain as adjuvant therapy, where rapid onset of action is required

• If mild pain relief is required and patient is nil by mouth and suppositories are contraindicated

• Not recommended for the treatment of fever

Indications for IV paracetamol

• Not more than 4g in 24 hours • When the patient is able to take oral

medications, switch to oral administration and stop IV as soon as possible

Results

Indication:• 100% of theatre patients were given IV paracetamol

for pain relief• 53.8% of ED patients were given IV paracetamol for

fever

Route of administration: • 61% of charts had multiple routes of administration

written (ie. IV/PO/PR) on the same order• Oral paracetamol given concurrently on 70% of

charts from theatre and ED

Discussion

• IV paracetamol is only indicated for pain relief and not recommended for treating fever

• Nil by mouth is not a criteria to use IV paracetamol

Discussion

• Potentially greater risk for toxicity exists if different forms of paracetamol are given and multiple routes of administration written up on the same order

• Patients who are tolerating other oral medications should have all IV orders changed to oral as soon as possibleMultiple charts (ie ED and medical wards) can also contribute to paracetamol overdose

Discussion

Cost comparisonProduct Route of

administrati on

Cost per dose (1g)

Daily cost (4g)

Perfalgan®1g IV $6.09 $24.36

Paracetamol Sandoz® 500mg

Oral tablets $0.02 $0.08

Panadol® 500mg

Suppositories $1.75 $7.00

Panadol® 240mg/5mL

Liquid solution

$0.18 $0.71

Discussion

Ward imprestED ICU

Paediatric Surgical

Same Day Theatre

Canning (medical ward) Benson (medical ward)

Conclusions

• IV paracetamol was inappropriately used in this hospital for the treatment of fever Supply of IV paracetamol should be restricted to wards due to significant cost differences between oral/rectal/IV preparations

• Appropriate education needs to be provided to staff in order to minimise medication error and ensure patient safetyThere is a need to formulate a guideline for IV paracetamol use at AHS

Proposed IV paracetamol guidelines for AHS

The use of IV paracetamol is indicated for patients who are nil by mouth AND where suppositories are contraindicated for post- operative and mild pain relief For severe post- operative pain where rapid onset of action is necessaryNot recommended for the treatment of fever Oral dosing should be resumed as soon as possible Each route of administration is to be written up as a separate orderClinical pharmacists are authorised to delete the administration route which is no longer applicable on the medication chart

Questions?

Thank you