CP-014 Intravenous acetaminophen use before and after protocol implementation in a teaching hospital

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Acetaminophen is an analgesic and antipyretic agent, recommended worldwide as a firstline treatment for the management of mild to moderate pain. There is a significant cost difference between parenteral and oral/rectal preparations of acetaminophen in Iran. Additionally, intravenous (IV) administration imposes an extra preparation and nursing burden. Invasive procedure complications is another concern. Although acetaminophen relieves mild to moderate pain and has a synergistic effect with other analgesics, the IV route should only be used if the oral or rectal dosage form cannot be utilised.


The primary objective of this study was to evaluate the utilisation of IV acetaminophen and clarify the role of protocol enforcement in decreasing the cost of pharmacotherapy and progressing to rational drug usage.

Material and methods

A pilot study was conducted in February 2015 to evaluate the prescribing appropriateness of IV acetaminophen. Data were obtained from a randomly selected group of 230 patients. A protocol for appropriate use of parenteral acetaminophen was designed by the pharmaceutical care department in accordance with drug monograph and reliable guidelines. The protocol was implemented in two phases: in phase one, the protocol was introduced to healthcare professionals via a newsletter, text messaging and face to face meetings with influential physicians. In the second phase, the pharmacists approved dispensing of IV acetaminophen to medical wards only if the physician’s order accompanied a signed paper protocol. The trend of IV acetaminophen utilisation was assessed during the intervention.


During February 2015, 5139 acetaminophen injections were prescribed for 1631 patients. Inappropriate orders were revealed in 41% of the dosage forms, 38% for duration and 50% for dosages. Only in 27% of patients were all three parameters correct. Following phase one, the number of prescribed IV acetaminophen doses decreased to 3152 for 932 patients in one month (approximate 38% reduction). After the second phase, the use of acetaminophen was 2328 injections in 808 patients after protocol enforcement. The net reduction was 55% after the two phase intervention.


Development and implementation of drug protocols could improve appropriate prescribing and reduce cost in hospital settings.


No conflict of interest

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