PMO-022 Are recommended guidelines for IV paracetamol prescription followed in susceptible gastroenterology patients?

Abstract

Introduction: IV Paracetamol use has increased since gaining EU drug approval in 2002, possibly due to its rapid onset and favourable side-effect profile.1 The recommended adult daily dose is 4 g/day. The standard daily dose may be high enough to cause acute liver failure in patients with certain Gastroenterological problems [hepatocellular insufficiency, chronic malnutrition2 (The British National Formulary (BNF) version 60 advises that IV Paracetamol should be reduced to 3 g/day in these susceptible patients.3 We aimed to assess if IV paracetamol prescriptions are in line with BNF guidance. Methods: A prospective, point prevalence audit of all patients receiving IV paracetamol was undertaken on 2 days, 2 weeks apart. All adult inpatients (excluding the Women's Department) at Arrowe Park Hospital were assessed. A list of all patients receiving IV paracetamol was identified through the electronic prescribing system. The case-notes of all these patients were reviewed for evidence of high-risk characteristics including; weight. Results: Over two audit days a total of 104 out of 1158 (9%) hospital inpatients were prescribed IV Paracetamol. Three patients were present on both days, therefore 101 sets of data were collected. 16 patients (16%) prescribed IV Paracetamol were identified as high risk (hepatocellular insufficiency, chronic malnutrition or chronic alcoholism), and 15 (94%) of these patients were not prescribed a reduced dose. This equates to a drug error in 1.3% of all inpatients. Conclusion: IV Paracetamol is prescribed very frequently. Prescription is common in susceptible Gastroenterology patients with malnutrition, liver disease and alcoholism. Almost all susceptible patients in this audit were prescribed an inappropriately high dosage of paracetamol. This may lead to significant adverse side effects in an already vulnerable group of patients. It is important to increase awareness of reduced dosages in susceptible patients. Locally an alert has been placed on the electronic prescribing system and we have increased Pharmacist and medical staff awareness of appropriate paracetamol doses. We suspect our audit findings may be similar in other hospitals.