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.
OBJECTIVE
Timely switching from intravenous to oral therapy ensures optimized treatment and efficient use of health care resources. Intravenous (IV) paracetamol is widely used for post-operative pain management but not always switched to the oral form in a timely manner, leading to unnecessary increase in expenditure. This study aims to evaluate the impact of a multifaceted intervention to promote timely switching from the IV to oral form in the post-operative setting.


METHODS
An evidence-based prescribing protocol was designed and implemented by the clinical pharmacy team in a single district general hospital in Egypt. The protocol specified the criteria for appropriate prescribing of IV paracetamol. Doctors were provided with information and educational sessions prior to implementation. A prospective, quasi-experimental study was undertaken to evaluate its impact on IV paracetamol utilization and costs. Data on monthly utilization and costs were recorded for 12 months before and after implementation (January 2012 to December 2013). Data were analysed using interrupted time series analysis.


RESULTS
Prior to implementation, in 2012, total spending on IV paracetamol was 674 154.00 Egyptian Pounds (L.E.) ($23,668.00). There was a non-significant (P > 0.05) downward trend in utilization (-32 ampoules per month) and costs [reduction of 632 L.E. ($222) per month]. Following implementation, immediate decrease in utilization and costs (P < 0.05) and a trend change over the follow-up period were observed. Average monthly reduction was 26% (95% CI: 24% to 28%, P < 0.001).


CONCLUSIONS
A multifaceted, protocol-based intervention to ensure timely switching from IV-to-oral paracetamol achieved significant reduction in utilization and cost of IV paracetamol in the first 5 months of its implementation.
Clinical Pharmacy Department, Faculty of Pharmacy, Cairo University, Cairo, Egypt.
Nirmeen
N
Sabry
Clinical Pharmacy Department, Faculty of Pharmacy, Cairo University, Cairo, Egypt.|Health Economics, Modelling and Systems Analysis (HeMaSa), Centre for Technology Enabled Health Research, Coventry University, Coventry, UK.
Dalia
http://orcid.org/0000-0002-2105-1937
D
Dawoud
Department of Anaesthesiology and Critical Care, Faculty of Medicine, Ain Shams University, Cairo, Egypt.
Adel
A
Alansary
Pragmatic Clinical Trials Unit (PCTU), Centre for Primary Care and Public Health, Queen Mary, University of London, London, UK.
Natalia
N
Hounsome
Health Economics, Modelling and Systems Analysis (HeMaSa), Centre for Technology Enabled Health Research, Coventry University, Coventry, UK.
Darrin
D
Baines
D000082:Acetaminophen / Q000008:administration & dosage* / Q000191:economics / Q000627:therapeutic use; D018712:Analgesics, Non-Narcotic / Q000008:administration & dosage* / Q000191:economics / Q000627:therapeutic use; D002985:Clinical Protocols; D004333:Drug Administration Routes; D004363:Drug Utilization / Q000706:statistics & numerical data; D017721:Hospital Costs / Q000706:statistics & numerical data; D006801:Humans; D065186:Interrupted Time Series Analysis; D059408:Pain Management / Q000191:economics / Q000379:methods*; D010149:Postoperative Pain / Q000188:drug therapy*; D010607:Pharmacy Service, Hospital / Q000379:methods; D011446:Prospective Studies; D013997:Time Factors
D018712:Analgesics, Non-Narcotic; D000082:Acetaminophen
IV-to-oral; evaluation; health economics; interrupted time series; paracetamol