Introduction
Oral and intravenous (IV) paracetamol have equivalent efficacy (Mallama et al); however, IV is significantly more expensive and more harmful to the environment. At Nottingham University Hospitals (NUH), IV paracetamol is approximately 200 times more expensive, and IV paracetamol has a carbon footprint 68 times higher than oral formulations (Myo et al). Despite this, inappropriate IV prescribing persists.
Our aim was to assess adherence to local and national prescribing guidelines (NHS Scotland) for paracetamol and evaluate the effect of an educational poster intervention and face to face teaching on improving prescribing practices.
Methods
A one-day point-prevalence audit was conducted across three surgical wards at NUH. Prescribing was assessed for compliance with guidelines recommending oral paracetamol unless contraindicated (e.g., unsafe swallow, vomiting, bowel obstruction). Being nil by mouth pre-operatively or asleep were not considered valid contraindications. Following the initial audit, informational posters were placed in strategic clinical areas, senior nurses delivered teaching, and a reaudit was conducted.
Results
In the first audit cycle, 79 patients were reviewed; 25 were prescribed IV paracetamol, of which 19 (76%) were inappropriate. The re-audit included 78 patients, with 17 prescribed IV paracetamol and 9 (47%) deemed inappropriate. The estimated annual cost of inappropriate prescribing decreased from £20,943.70 to £9,920.70 following the intervention.
Conclusion
The poster intervention and teaching sessions improved prescribing compliance, highlighting the utility of simple educational tools in promoting best practice. However, significant non-compliance remained, indicating that further multifaceted educational strategies are needed to optimise prescribing behaviour.
Authors
Josh Lambert
Nottingham University Hospitals NHS Trust, Nottingham, United Kingdom
Sepand Malex
Nottingham University Hospitals NHS Trust, Nottingham, United Kingdom
Catherine Leng
Nottingham University Hospitals NHS Trust, Nottingham, United Kingdom
Alexandra Fielding
Nottingham University Hospitals NHS Trust, Nottingham, United Kingdom