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

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.

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.

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.

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.