CLINICAL AUDIT ON USE OF ORAL VERSUS INTRAVENOUS PARACETAMOL IN FEBRILE PATIENTS AT PAEDIATRIC ONCOLOGY UNIT SHAUKAT KHANUM MEMORIAL CANCER HOSPITAL AND RESEARCH CENTER PESHAWAR

Abstract

Background: Intravenous (IV) paracetamol is frequently administered to febrile pediatric patients despite oral formulations being equally efficacious, more cost-effective, and easier to administer. Inappropriate IV use not only increases healthcare costs but also exposes patients to unnecessary procedural risks and increases work burden on the nursing staff while administering the drug. In the absence of formal national guidelines, rational prescribing becomes a matter of local policy and practice adherence.

Objective:  The main objectives of this audit was to look for the proportion of oral and IV paracetamol, to assess the appropriateness of IV paracetamol use  in febrile patients in emergency and inpatient departments  Pediatrics unit SKMCH Peshawar ,to  evaluate the impact of educational interventions on prescribing behavior.

Methods: A retrospective clinical audit was conducted at Shaukat Khanum Memorial Cancer Hospital and Research Centre (SKMCH & RC), Peshawar. The first audit cycle included 173 febrile pediatric patients from October to December 2023, with data extracted from the hospital information system. Departmental standards defined justified IV use. A re-audit was conducted from July to September 2024 after implementing multi-level educational interventions for physicians, nurses, and pharmacists. Data were analyzed descriptively to assess the proportion of oral and IV paracetamol and to look for the proportion of justified versus unjustified IV paracetamol use.

Results: In the first cycle, 96.8% of patients in the emergency department and 92.3% in inpatient care received IV paracetamol, with only 4.3% and 0% justification rates, respectively. Post-intervention, oral paracetamol use improved from 3.2 % to 87 % in Emergency room and from 2.6 % to 70 % in Inpatient setting. IV paracetamol justification rates improved from 4.3 % to 71 % in emergency room while from 0 % to 79 % in inpatient settings. Monthly IV paracetamol consumption dropped from 372 doses (PKR 72,912) to 30 doses (PKR 5,880), reflecting enhanced adherence to standards.

Conclusion: Educational interventions improved rational prescribing of oral and IV paracetamol, both in inpatient and emergency settings. However, continuous monitoring, training, and system-level support are necessary to sustain evidence-based IV paracetamol use.