{
  "abstract": "Aim A retrospective audit to compare prescribing of intravenous paracetamol before and during a period of prescribing restrictions to assess if an intervention designed to reduce errors would also reduce prescription numbers.Method Prescribing of intravenous (IV) paracetamol was restricted to consultant-only prescribing in a paediatric intensive care unit (PICU) for six weeks following a series of prescribing errors. Prescription numbers were retrospectively compared to the previous six weeks to quantify the impact on prescription numbers.An audit was performed using electronic prescribing software to determine how many patients were prescribed paracetamol during each of these time periods, and by which route.Results 868 doses of paracetamol were prescribed (145 separate prescriptions) during the six week period of restrictions, for 75 patients. Of these, 579 doses (67%) were via the gastro-enteral route. 9 doses (1%) were rectal and the remaining 280 doses (32%) were IV.720 doses of paracetamol were prescribed (134 separate prescriptions) for 95 patients during the previous six weeks. Of these, 419 doses (59%) were via the gastro-enteral route. 301 doses (41%) were IV. None were rectal.Conclusion Fewer doses of IV paracetamol were administered during the period of restrictions (32% vs 41%), despite higher overall paracetamol prescriptions and doses, suggesting that there is perhaps overuse of the IV form under normal circumstances. Consultants in this PICU do not routinely prescribe medicines, and during the restricted period, prescriptions of IV paracetamol had to be requested on an individual patient basis by the nursing or junior medical team. In comparison, prior to this, all prescribers were able to prescribe IV paracetamol manually or via electronic Order Sets.More paracetamol prescriptions were written during the period of restrictions, despite lower numbers of patients treated with paracetamol i.e. patients were changing from one route to another. This suggests that prescribers and nurses were more reactive to changes in clinical status (such as no longer being nil by mouth) and changing routes more readily than in the period before restrictions were introduced. This has implications for cost, complications (IV drug administration is associated with greater risk of complications1) and carbon footprint2; however, re-prescribing carries a risk of error with each new prescription although most of the risk of IV versus other routes is related to administration.3 Of note, no rectal doses were given before restrictions were introduced. Rectal doses are markedly more expensive than liquid or tablet doses, but similar in price to IV doses depending on suppository strength. Carbon footprint, nursing costs and sundries are much lower with rectal than IV administration.References Westbrook JI, Li L, Woods A, et al. Risk factors associated with medication administration errors in children: a prospective direct observational study of paediatric inpatients. Drug Safety 2024;47(6):545 –556.Eii MN, Walpole S, Aldridge C. Sustainable practice: prescribing oral over intravenous medications. British Medical Journal 2023;383:e075297.Sutherland A, Canobbio M, Clarke J, et al. Incidence and prevalence of intravenous medication errors in the UK: a systematic review. Europe Journal of Hospital Pharmacy 2020;27:3–8.",
  "authors": [
    {
      "affiliations": [
        "NHS Greater Glasgow And Clyde, UK"
      ],
      "name": "Nicola Wilson"
    },
    {
      "affiliations": [
        "NHS Greater Glasgow And Clyde, UK"
      ],
      "name": "Jennifer Kimmins"
    },
    {
      "affiliations": [
        "NHS Greater Glasgow And Clyde, UK"
      ],
      "name": "Andrew Stockton"
    }
  ],
  "title": "P10 Review of intravenous paracetamol prescribing before and during a period of restrictions",
  "uid": "0d29e54e-9227-559e-9c84-9f7c9150cb0b"
}