Category: Professional Posters
Purpose: Intravenous (IV) acetaminophen is administered to surgical ENT patients in the Operating Room when a dose of oral acetaminophen is not administered in Perioperative Admit. IV acetaminophen is more expensive than oral acetaminophen but is not clinically superior to oral acetaminophen. Our aim is to decrease the use of intraoperative IV acetaminophen in the surgical ENT population from 24% of total intraoperative IV acetaminophen administrations to < 5% of total intraoperative IV acetaminophen administrations via the implementation of a nursing driven standing order policy for the ordering and administration of oral acetaminophen upon arrival in Perioperative Admit.
Methods: A standing order was written and approved to allow nursing driven ordering and administration of oral acetaminophen per protocol. All patients presenting to Perioperative Admit for adenoidectomy, tonsillectomy, and tympanostomy tube placement receive a dose or oral acetaminophen if no contraindications exist.
After implementation of the standing order, dispense data from Tableau Interactive Data Visualization Software was obtained for the initial trial period of 7 weeks (February to March 2019). Rates of IV acetaminophen administration in our target population before and after implementation of the standing order were assessed. To confirm the trend of decreased rates of IV acetaminophen administration by observing increased rates of oral acetaminophen administration, Omnicell dispenses of oral acetaminophen from February to March 2019 were compared to the same period one year prior (February to March 2018).
Results: Dispense data was analyzed for a 7-week trial period of February 11 to March 31, 2019 following implementation of the standing order policy allowing nursing driven ordering and administration of oral acetaminophen to patients arriving in Perioperative Admit. One dose (264mg) of IV acetaminophen was administered to a surgical ENT patient intraoperatively due to a contraindication to receiving oral acetaminophen preoperatively. The one dose administered to the surgical ENT patient accounted for 1.7% of IV acetaminophen administrations in the Operating Room for all patients undergoing all procedures during the trial period.
During the same 7-week period in 2018, surgical ENT patients accounted for 24% of all intraoperative IV acetaminophen administrations in the Operating Room.
16,406.8mg of IV acetaminophen was administered during the 7-week baseline period in 2018, 264mg was administered in the 7-week trial period in 2019. This is a 98.4% reduction. This reduction translates to cost savings estimated to be $3473.60 annually for our institution.
Conclusion: Implementation of a standing order policy allowing nurses in Perioperative Admit to order and administer oral acetaminophen preoperatively decreased administration of IV acetaminophen intraoperatively in surgical ENT patients at our institution. Rates of oral acetaminophen preoperatively increased with implementation of the standing order policy. Reduction in doses of IV acetaminophen translated into cost savings for our institution.