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Using a Patient Group Direction (PGD) for Oral Paracetamol pre-medication in paediatric day surgery

Edward Scott, Upendra CHENNASUBBANNAGARI, Sivanth SIVAKUMAR, Emily Saffer
Kings College Hospital NHS Trust, London, United Kingdom


Introduction: Intravenous (IV) paracetamol is not known to offer any analgesic benefit compared with the oral route. Its’ use is associated with more drug errors, CO2 emissions and is more expensive. Patient Group Directions (PGDs) enable nurses to supply and/or administer medication to a defined group of patients without the need for a prescription. The purpose of this quality improvement project was to increase the use of oral paracetamol pre-medication in children attending for day surgery at Kings College Hospital by implementation of a PGD, and consequently decreasing IV use.

Methods: A snap-shot audit was carried out at KCH in January 2023 to ascertain how paracetamol was being used in children undergoing day surgery. Following this, a PGD was implemented which incorporated a training process, competencies and visual aid for nurses to administer paracetamol safely to paediatric patients pre-operatively. Re-audit will be carried out in April 2023 once the PGD has been fully implemented.

Results: 20 patients were included in the initial audit. The mean age was 10.1 years, 18 received IV paracetamol, 1 received oral paracetamol (5%) and 1 received no paracetamol. Following the re-audit, proportions of children receiving oral or IV paracetamol will be reported, as well as time interval from administration to induction of anaesthesia, and incidence/description of any drug errors.

Conclusions: We hope to show that a simple intervention to change practice from using IV to oral paracetamol can be safe, empower nursing staff, be cost effective and have significantly less environmental impact.