Prescribing patterns and administration of intravenous paracetamol: a clinical audit

Background: Intravenous (IV) paracetamol was authorised by the Irish Medicines Board in 2003. Thereafter, the Drugs and Therapeutics Committee (DTC) in the study hospital added the IV preparation to the hospital formulary in September 2005. The DTC policy allows for IV administration only when the oral (PO), rectal (PR) and enteral routes are not available.

Aim: To identify the prescribing and administration patterns of IV paracetamol, to assess its appropriateness and to identify the associated opportunity cost.

Methods: A retrospective survey was conducted on patients who were prescribed paracetamol on adult medical and surgical wards. The patients were randomly selected and their healthcare charts were reviewed over a two-week period in September 2008. 

Results: A total of 1,934 administrations were surveyed. Compliance with policy was demonstrated in 94.3% of administrations. The opportunity cost of using IV instead of PO tablets was found to be in excess of €23,000 per annum for the study hospital.

Conclusion: The majority of paracetamol administration was compliant with hospital policy. The cost implications for inappropriate administration were identified by calculating the difference incurred when IV was chosen over the equally efficacious PO/PR routes. Current findings and recommendations can be presented to relevant stakeholders (doctors, nurses and pharmacists) in order to review the usage of IV paracetamol and improve adherence with policy guidelines.