A Quality Improvement Initiative to Decrease Inappropriate Intravenous Acetaminophen Use at an Academic Medical...

Area of Science:

• Pharmacoeconomics
• Quality Improvement in Healthcare
• Pain Management

Background:

• Intravenous acetaminophen (IV APAP) became widely used for pain management after its US availability in 2011.
• A significant price increase in 2014 made IV APAP a major expense at the study institution.
• The high cost prompted a need to optimize its prescribing and reduce expenditures.

Purpose of the Study:

• To implement strategies for appropriate IV APAP prescribing.
• To achieve substantial cost reductions associated with IV APAP utilization.
• To evaluate the impact of interventions on medication spending and patient care.

Main Methods:

• A quality improvement project utilizing Plan-Do-Study-Act (PDSA) methodology was conducted at an academic medical center.
• Interventions included refining restriction criteria, implementing electronic clinical decision support, staff education, and pharmacist-led enforcement.
• Statistical process control charts monitored IV APAP utilization and spending from 2010 to 2017.

Main Results:

• Five PDSA cycles led to a dramatic decrease in monthly IV APAP spending, from an average of $56,038 to $5,822.
• The interventions achieved an 80% annual cost savings, approximating $600,000 per year.
• No significant changes in the use of IV opioids, IV ketorolac, or oral ibuprofen were observed.

Conclusions:

• Restrictions on IV APAP can be safely and effectively implemented in hospitals.
• Cost-effective medication management is achievable without compromising pain control or increasing reliance on other analgesics.
• This study highlights successful strategies for controlling pharmaceutical expenditures through targeted quality improvement initiatives.