A Drug Utilization Evaluation Study of Intravenous Acetaminophen in a Large Teaching Hospital

  • Zeinab Esfahani
  • Ramin Abrishami Department of Clinical Pharmacy, Faculty of Pharmacy, Pharmaceutical Sciences Branch, Islamic Azad University, Tehran -Iran (IAUPS)
  • Seyed Ruhollah Mousavinasab Department of Clinical Pharmacy, Faculty of Pharmacy, Shiraz University of Medical Sciences, Shiraz, Iran
  • Nazafarin Hatami-Mazinani Department of Clinical Pharmacy, Faculty of Pharmacy, Shiraz University of Medical Sciences, Shiraz, Iran

Abstract

Background: IV acetaminophen has become the most commonly chosen analgesic medication in critical care settings. Overall, the cost of the drug is higher than oral and rectal acetaminophen. As a result, numerous studies have been performed to evaluate the appropriateness of IV acetaminophen use based on guidelines. A lot of studies have shown that there is poor quality in compliance with guideline in developing countries. Current study aims to evaluate prescribing behavior of IV acetaminophen regimens in hospitalized adults in Tehran, Iran.

 Material and methods: We reviewed 277 patients' charts (including 137 men and 140 women) with age ranged between 18-65 years in Ziaeian hospital, Tehran, Iran. Demographic data and clinical and lab parameters such as blood urea nitrogen (BUN) and creatinine levels, name of ward, prescribing reason, doses, dose intervals, number of doses, type of vehicle used and durations of infusion were collected and recorded for analysis.

Results: Our results showed that guideline concordance was seen only in 20 (7.22%) out of 277 patients. IV acetaminophen is prescribed mostly by emergency medicine specialists, and it is more inappropriately prescribed by these specialists in comparison to other specialists. It was also found that non-compliance of IV acetaminophen prescribing with guideline imposes 1038 USD additional expenditure on health care system of the hospital. Indirect costs resulting from preventable adverse events, physician and nurse manpower and time was not calculated.

Conclusion: The evaluation of prescribing indicators showed low quality prescription by medical specialists. The pattern of prescribing depending on the medical specialties was also different. In addition, overuse and misuse of IV acetaminophen imposes substantial cost and the economic burden on healthcare system.

References

1. Sabry N, Dawoud D, Alansary A, Hounsome N, Baines. Journal of evaluation in clinical practice. 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. 2015;21(6):1081-8.
2. De Vries T, Henning R, Hogerzeil HV, Fresle D, Policy M, Organization WH. Guide to good prescribing: a practical manual. Geneva: World Health Organization; 1994.
3. Larkin MJTL. Evidence-based prescribing made simple. The Lancet. 2001;357(9254):448.
4. Bates DW, Spell N, Cullen DJ, Burdick E, Laird N, Petersen LA, et al. JAMA. The costs of adverse drug events in hospitalized patients. 1997;277(4):307-11.
5. Classen DC, Pestotnik SL, Evans RS, Lloyd JF, Burke JP. JAMA. Adverse drug events in hospitalized patients: excess length of stay, extra costs, and attributable mortality. 1997;277(4):301-6.
6. Schentag JJ, Ballow CH, Fritz AL, Paladino JA, Williams JD, Cumbo TJ, et al. Diagnostic microbiology and infectious disease. Changes in antimicrobial agent usage resulting from interactions among clinical pharmacy, the infectious disease division, and the microbiology laboratory. 1993;16(3):255-64.
7. Ibrahim KH, Gunderson B, Rotschafer JCJCcm. Intensive care unit antimicrobial resistance and the role of the pharmacist. Critical care medicine. 2001;29(4):N108-N13.
8. Kane RL, Garrard JJ. JAMA. Changing physician prescribing practices: regulation vs education. 1994;271(5):393-4.
9. Rifenburg RP, Paladino JA, Hanson SC, Tuttle JA, Schentag J. American journal of health-system pharmacy. Benchmark analysis of strategies hospitals use to control antimicrobial expenditures. 1996;53(17):2054-62.
10. Pestotnik SL, Classen DC, Evans RS, Burke JP. Annals of internal medicine. Implementing antibiotic practice guidelines through computer-assisted decision support: clinical and financial outcomes. 1996;124(10):884-90.
11. Belongia EA, Schwartz BJ. BMJ. Strategies for promoting judicious use of antibiotics by doctors and patients. 1998;317(7159):668-71.
12. American Society of Hospital Pharmacists. Am J Hosp Pharm. ASHP guidelines on the pharmacist's role in drug‐use evaluation. 1988;45:385-6.
13. Lipton HL, Bird JA. Medical Care. Drug utilization review in ambulatory settings: state of the science and directions for outcomes research. 1993:1069-82.
14. Lipton HL, Bird JA. Clinical Pharmacology & Therapeutics. Therapeutics. Drug utilization review: State of the art from an academic perspective. 1991;50:616-9.
15. Hartzema AG, Porta MS, Tilson HH, Serradell J, Bjornson DC, Hartzema AG. Drug intelligence & clinical pharmacy. Drug utilization study methodologies: national and international perspectives. 1987;21(12):994-1001.
16. Malesker MA, Bruckner AL, Loggie B, Hilleman DE. Jurnalul de Chirurgie. Intravenous Acetaminophen: Assessment of Medication Utilization Evaluation Data in Peri-operative Pain Management. 2015;10(4).
17. Smith HS. Pain physician. Potential analgesic mechanisms of acetaminophen. 2009;12(1):269-80.
18. Heaton PC, Cluxton Jr RJ, Moomaw CJ. Journal of the American Pharmacists Association. Acetaminophen overuse in the Ohio Medicaid population. 2003;43(6):680-4.
19. White PF. Anesthesia and Analgesia. The role of non-opioid analgesic techniques in the management of pain after ambulatory surgery. 2002;94(3):577-85.
20. White PF. Anesthesia and Analgesia. The changing role of non-opioid analgesic techniques in the management of postoperative pain. 2005;101(5S):S5-S22.
21. Albaladejo P, Caillet B, Moine P, Vigue B, Decorps-Declere A, Benhamou D. Presse medicale (Paris, France: 1983). Off-label prescriptions in an adult surgical intensive care unit. 2001;30(30):1484-8.
22. http://www.fda.gov.ir/item/2630. [
23. Harrington D. Today's hospitalist special report. IV Acetaminophen: The hospitalist's perspective.
24. Zuppa AF, Adamson PC, Mondick JT, Davis LA, Maka DA, Narayan M, et al. The Journal of Clinical Pharmacology. Drug utilization in the pediatric intensive care unit: monitoring prescribing trends and establishing prioritization of pharmacotherapeutic evaluation of critically ill children. 2005;45(11):1305-12.
25. Fitzgerald M. Irish medical journal. Unlicensed and off label drug use for children with child psychiatric problems. 1999;92(2):284.
26. Abdelmageed WM, Al Taher WM. Egyptian Journal of Anaesthesia. Preoperative paracetamol infusion reduces sevoflurane consumption during thyroidectomy under general anesthesia with spectral entropy monitoring. 2014;30(2):115-22.
27. Smith AN, Hoefling VC. Pharmacy practice. A retrospective analysis of intravenous acetaminophen use in spinal surgery patients. 2014;12(3).
28. Shaffer EE, Pham A, Woldman RL, Spiegelman A, Strassels SA, Wan GJ, et al. Advances in therapy. Estimating the effect of intravenous acetaminophen for postoperative pain management on length of stay and inpatient hospital costs. 2016;33(12):2211-28.
29. Ghiculescu R, Kubler P, Gleeson P. Internal medicine journal. Drug utilization evaluation of iv paracetamol at a large teaching hospital. 2007;37(9):620-3.
30. Hirate J, Zhu CY, Horikoshi I, Bhargava VO. Biopharmaceutics and drug disposition. disposition d. First‐pass metabolism of acetaminophen in rats after low and high doses. 1990;11(3):245-52.
31. Sadeghian G-H, Safaeian L, Mahdanian A-R, Salami S, Kebriaee-Zadeh J. Iranian journal of pharmaceutical research. Prescribing quality in medical specialists in Isfahan, Iran. 2013;12(1):235.
32. Dooley MJ, Allen KM, Doecke CJ, Galbraith KJ, Taylor GR, Bright J, et al. British journal of clinical pharmacology. A prospective multicentre study of pharmacist initiated changes to drug therapy and patient management in acute care government funded hospitals. 2004;57(4):513-21.
33. Hoti K, Hughes J, Sunderland B. International journal of clinical pharmacy. Expanded prescribing: a comparison of the views of Australian hospital and community pharmacists. 2013;35(3):469-75.
Published
2020-02-03
How to Cite
1.
Esfahani Z, Abrishami R, Mousavinasab SR, Hatami-Mazinani N. A Drug Utilization Evaluation Study of Intravenous Acetaminophen in a Large Teaching Hospital. J Pharm Care. 7(4):87-93.
Section
Original Article(s)