Evaluation of a protocol-based intervention to promote timely switching from intravenous to oral paracetamol for post-operative pain management: an interrupted time series analysis

Nirmeen Sabry, Dalia M Dawoud, Adel Alansary, Natalia Hounsome, Darrin Baines

Research output: Contribution to journalArticlepeer-review

5 Citations (Scopus)

Abstract

RATIONALE, AIMS AND OBJECTIVES: Timely switching from intravenous to oral therapy ensures optimized treatment and efficient use of health care resources. Intravenous (IV) paracetamol is widely used for post-operative pain management but not always switched to the oral form in a timely manner, leading to unnecessary increase in expenditure. This study aims to evaluate the impact of a multifaceted intervention to promote timely switching from the IV to oral form in the post-operative setting.

METHODS: An evidence-based prescribing protocol was designed and implemented by the clinical pharmacy team in a single district general hospital in Egypt. The protocol specified the criteria for appropriate prescribing of IV paracetamol. Doctors were provided with information and educational sessions prior to implementation. A prospective, quasi-experimental study was undertaken to evaluate its impact on IV paracetamol utilization and costs. Data on monthly utilization and costs were recorded for 12 months before and after implementation (January 2012 to December 2013). Data were analysed using interrupted time series analysis.

RESULTS: Prior to implementation, in 2012, total spending on IV paracetamol was 674 154.00 Egyptian Pounds (L.E.) ($23,668.00). There was a non-significant (P > 0.05) downward trend in utilization (-32 ampoules per month) and costs [reduction of 632 L.E. ($222) per month]. Following implementation, immediate decrease in utilization and costs (P < 0.05) and a trend change over the follow-up period were observed. Average monthly reduction was 26% (95% CI: 24% to 28%, P < 0.001).

CONCLUSION: A multifaceted, protocol-based intervention to ensure timely switching from IV-to-oral paracetamol achieved significant reduction in utilization and cost of IV paracetamol in the first 5 months of its implementation.

Original languageEnglish
Pages (from-to)1081-8
Number of pages8
JournalJournal of Evaluation in Clinical Practice
Volume21
Issue number6
DOIs
Publication statusPublished - Dec 2015

Keywords

  • Acetaminophen/administration & dosage
  • Analgesics, Non-Narcotic/administration & dosage
  • Clinical Protocols
  • Drug Administration Routes
  • Drug Utilization/statistics & numerical data
  • Hospital Costs/statistics & numerical data
  • Humans
  • Interrupted Time Series Analysis
  • Pain Management/economics
  • Pain, Postoperative/drug therapy
  • Pharmacy Service, Hospital/methods
  • Prospective Studies
  • Time Factors

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