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Introduction and audit of intravenous paracetamol at a tertiary paediatric teaching hospital
G M Palmer1, S P Chen, K R Smith
1Department of Anaesthesia and Pain Management, Royal Children's Hospital, Victoria, Australia.
Insights
Intravenous (IV) paracetamol is effective for paediatric pain management, though more costly than rectal forms. Audits showed appropriate use and minimal dosing errors, supporting wider IV paracetamol adoption in children.
Area of Science:
- Pediatric Anesthesiology
- Clinical Pharmacology
- Health Economics
Background:
- Intravenous (IV) paracetamol offers an attractive analgesic option, but data on its pediatric use is limited.
- A tertiary pediatric center introduced IV paracetamol under restricted prescribing rights.
Purpose of the Study:
- To audit the initial use and cost impact of IV paracetamol in a pediatric setting.
- To assess the appropriateness of indications and identify any safety concerns.
Main Methods:
- Retrospective review of medical records for children and neonates receiving IV paracetamol.
- Data collected included demographics, diagnoses, indications, dosing, co-administered analgesics/antiemetics, and liver function tests.
- Expenditure for IV paracetamol was compared to its rectal alternative.
Main Results:
- 1216 doses of IV paracetamol were administered to 126 pediatric patients.
- IV paracetamol expenditure was 3.9 times higher than rectal paracetamol.
- Indications were appropriate: 97% nil oral, 41% vomiting, 17% replacing rectal route, 3% avoiding parenteral morphine.
- Only five patients had incorrect dosing (3 prescription errors, 2 guideline deviations), none severe.
- No liver function test abnormalities were directly attributed to IV paracetamol.
Conclusions:
- The audit demonstrated appropriate and safe use of IV paracetamol in pediatric patients.
- Findings supported an application to extend prescribing rights for IV paracetamol.
- This data provides valuable insights for other Australian centers considering IV paracetamol introduction.
Abstract:
Although intravenous (i.v.) paracetamol is an attractive analgesic, there is little information on its paediatric use. During an introduction phase with limited prescribing rights, an audit was performed to assess its use and cost impact at a tertiary paediatric centre. Patients receiving IV paracetamol prescribed by two pain specialists for restricted indications had their medical records retrospectively reviewed for age, weight, diagnosis, indications/dose for IV (and other route) paracetamol/other analgesics/antiemetics, vomiting/oral intake and liver function tests if performed. One-hundred-and-twenty-one children and five neonates received 1216 (median 8 each) doses of paracetamol IV Audited expenditure for IV paracetamol was 3.9 times the rectal alternative ($3435 vs. $875). Indications were appropriate, with 97% of patients nil oral, 41% vomiting, 17% having rectal route replaced and 3% avoiding parenteral morphine. Only five patients received incorrect dosing: three through prescription errors and two as guideline deviations; none were considered dangerous. No liver function test derangements could be directly attributed to paracetamol. This data facilitated our application to extend prescribing rights for IVparacetamol within our institution. As there is limited information or local experience with the use of IVparacetamol in paediatric settings in Australia, our data may be of use to other centres considering the introduction of the IV form of this agent.
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