Antipyretic orders in a university hospital

Antipyretics are prescribed for many hospitalized patients, but details concerning prescribing practices are not known. This study was designed to determine the incidence and format of antipyretic orders in a university-based tertiary-care center, and to ascertain whether orders are correlated with patient characteristics or hospital services.

The records of 300 randomly selected patients on the medicine, general surgery, neurosurgery, and obstetrics and gynecology services, and of 75 patients admitted with pneumonia and fever were retrospectively reviewed using a standardized data form.

Orders for acetaminophen prn (as needed), without further explanation, were interpreted by the nursing staff as antipyretic orders; 78% of patients with such an order and fever received acetaminophen during the febrile episode. If orders of this type were included, 153 (51%) of the randomly selected patients received an antipyretic order. Gender, age, duration of hospitalization, intensive care unit residence, fever, and presence of a condition worsened by fever were not significant independent predictors of antipyretic prescription, but documented infection and hospitalization on the medicine and neurosurgery services were, with adjusted odds ratios of 2.5 (95% confidence interval [CI] 1.3 to 5.0), 9.4 (95% CI 3.6 to 25), and 14 (95% CI 5.0 to 41), respectively. Of patients who received an antipyretic order, 70% had an admission order for antipyretics; 26%, an order prompted by fever; and 79%, an order while afebrile. In 86%, the order was written prn without further explanation. Around-the-clock dosing, automatic stop orders, and acknowledgement and justification of orders were rare.

Antipyretic orders are routine and correlate more strongly with hospital service than with individual patient characteristics. They are umprecisely written and generally leave decisions about antipyretic administration to the complete discretion of the nursing staff.