Controlling postoperative use of i.v. acetaminophen at an academic medical center

American Journal of Health-system Pharmacy : AJHP : Official Journal of the American Society of Health-System Pharmacists
William R VincentDavid Twitchell

Abstract

Results of an interprofessional formulary initiative to decrease postoperative prescribing of i.v. acetaminophen are reported. After a medical center added i.v. acetaminophen to its formulary, increased prescribing of the i.v. formulation and a 3-fold price increase resulted in monthly spending of more than $40,000, prompting an organizationwide effort to curtail that cost while maintaining effective pain management. The surgery, anesthesia, and pharmacy departments applied the Institute for Healthcare Improvement's Model for Improvement to implement (1) pharmacist-led enforcement of prescribing restrictions, (2) retrospective evaluation of i.v. acetaminophen's impact on rates of opioid-related adverse effects, (3) restriction of prescribing of the drug to 1 postoperative dose on select patient care services, and (4) guideline-driven pain management according to an enhanced recovery after surgery (ERAS) protocol. Monitored metrics included the monthly i.v. acetaminophen prescribing rate, the proportion of i.v. acetaminophen orders requiring pharmacist intervention to enforce prescribing restrictions, and prescribing rates for select adjunctive analgesics. Within a year of project implementation, the mean monthly i.v. acetaminop...Continue Reading

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Citations

Sep 28, 2018·American Journal of Health-system Pharmacy : AJHP : Official Journal of the American Society of Health-System Pharmacists·Steven B LevyDavid McCoy
Mar 1, 2019·JAMA : the Journal of the American Medical Association·Stavros G MemtsoudisHenrik Kehlet
Jun 9, 2020·Journal of Perioperative Practice·Tito D Tubog
Apr 4, 2021·Healthcare·Sara J HylandRobert K Cleary
May 1, 2021·Journal of Clinical Medicine·Chinyere Egbuta, Keira P Mason

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