Using Quality Improvement to Reduce IV Acetaminophen Use in a PICU

Area of Science:

• Pharmacoeconomics
• Quality Improvement Science
• Pediatric Critical Care

Background:

• Intravenous acetaminophen is a high-frequency, high-cost medication in pediatric intensive care units (PICUs).
• Optimizing its use can improve medication-related variable costs and overall healthcare value.

Purpose of the Study:

• To improve medication-related variable ICU costs by increasing value associated with intravenous acetaminophen.
• To reduce the prescribing frequency of IV acetaminophen in a tertiary PICU.

Main Methods:

• A structured quality improvement initiative was implemented using the Institute for Healthcare Improvement's Model for Improvement.
• Interventions included staff education, order set optimization, improved medication transition protocols, and enhanced pharmacy dispensing.

Main Results:

• The study achieved a 40% reduction in IV acetaminophen doses, decreasing from 0.55 to 0.33 doses per patient day.
• This reduction resulted in an estimated cost savings of $35,507 annually.
• Concurrently, enteral and rectal acetaminophen use increased, indicating a successful transition to alternative formulations.

Conclusions:

• Optimizing intravenous acetaminophen prescribing is an effective strategy to improve value and reduce costs in the PICU.
• Quality improvement initiatives targeting high-frequency, high-cost medications can yield significant financial and clinical benefits.