Background- Paracetamol is one of the most frequently administered analgesic medications in intensive care, with two thirds of patients receiving it in the ICU. Recently, intravenous formulations of paracetamol are administered more frequently than oral formulations despite no clinically significant difference in analgesic or antipyretic efficacy. IV formulations are 26 times more expensive than enteral formulations to administer, requiring additional equipment and a higher carbon footprint. Understanding local prescribing trends and the rationale for formulation choice is essential for promoting sustainable medication use. Where oral administration is not feasible, rectal paracetamol- although rarely used- may represent a safe and cost-effective alternative. Exploring clinician comfort with this option allows for a more complete understanding of feasible enteral pathways.
Aim and Hypothesis- This study aims to evaluate IV and enteral paracetamol use in the UHG ICU and explore the influences on clinician’s decisions. We hypothesize that although IV paracetamol is sometimes necessary and preferred to rectal administration; it is also selected for non-clinical reasons. Increased awareness of sustainability and cost with updated protocols, will enable a behaviour change.
Objectives
Quantify IV and oral paracetamol use in UHG ICU over a 5-month period.
Evaluate the influences and barriers to clinician’s formulation decision to influence future protocols.
Assess views on feasibility of rectal paracetamol where oral use is not possible.
Methods- This will be a retrospective chart review and mixed-methods qualitative study design.
Phase 1: Retrospective review of ICU paracetamol administrations across a 6-month period, assessing prescribing patterns. Phase 2: interviews/questionnaires with ICU clinicians to explore sustainability perceptions and route reasoning. Data will undergo descriptive and thematic analysis respectively.
Expected Outcomes- This project will identify factors influencing paracetamol route decisions, and associated sustainability impacts. Findings will practically inform recommendations for future ICU protocols to reduce unnecessary IV paracetamol use.