50 - Evaluation of Intravenous Acetaminophen Prescribing Patterns in the Pediatric Population at Stony Brook Children’s Hospital

Poster Number: 50
Publication Number: 50.2968

Background: Acetaminophen is the most commonly prescribed antipyretic and analgesic medication for children. Availability in rectal (PR) and intravenous (IV) forms has allowed widespread use in patients where oral (PO) treatment is contraindicated (NPO). Despite the higher cost of IV acetaminophen, its use remains popular. The data on its superiority to oral acetaminophen as an analgesic or its opioid reduction potential is variable in children. The antipyretic efficacy of oral and IV acetaminophen are similar. Additionally, studies have shown that there is no difference in the antipyretic effects of oral versus rectal acetaminophen. Therefore, rectal acetaminophen is a safe and effective alternative to oral acetaminophen.

Objective: We aim to decrease the rate of IV acetaminophen prescriptions for non-surgical patients within Stony Brook Children’s Hospital (SBCH) by 15% between 12/1/2022 and 6/1/2023.

Design/Methods: A process map revealed many different disciplines are responsible for IV acetaminophen ordering, however we elected to focus on inpatient non-surgical patients given the variable literature on IV acetaminophen and reduction in opioid use for post-op pain. Retrospective data evaluated acetaminophen prescribing practices on the inpatient pediatric units at SBCH from July 2021 to January 2022 (pre- intervention). Patients were considered appropriate for PO substitution if they were allowed enteral medications and were appropriate for PR substitution if they were non-neutropenic without anorectal malformations. Subsequently, several Plan-Do-Study-Act (PDSA) cycles were undertaken focusing on peer-driven education about the high cost of IV acetaminophen and the feasibility of using rectal acetaminophen, standardization of care and EMR optimization.

Results: Although the number of IV acetaminophen orders increased slightly following the initial PDSA cycle, there has been a sustained reduction in the number of IV acetaminophen orders with the potential for conversion to PO/PR, from an average of 850/1000 patient days pre-intervention to 184/1000 patient days following our most recent intervention. This indicates a more judicious use of IV acetaminophen.

Conclusion(s): Rectal acetaminophen continues to be an important factor in fever control in pediatrics. Through a staged approach centered on education, standardization of care and optimization of electronic workflow, the reduction in use of IV acetaminophen is feasible. The benefits of cost savings and timelier administration of acetaminophen must be balanced against the risk of patient discomfort/dissatisfaction with the PO/PR routes of acetaminophen.