Audit of Paracetamol Prescriptions in Paediatric Surgical Patients

Abstract

100 inpatient prescriptions (71 elective and 29 non-elective) and 35 discharge prescriptions were analysed.1. Weight was annotated for 84% of inpatient prescriptions and 94% of discharge prescriptions; height was not documented for any patient. Therefore data was analysed basing IBW on 50th centile of the UK growth charts.2. The following results are based on IBW: ▸ Six inpatients prescribed oral paracetamol were classified as overweight or obese; doses ranged from 17.4-30 mg/kg/dose. ▸ Four patients prescribed IV paracetamol were classified as overweight or obese; doses ranged from 20-23 mg/kg/dose. ▸ Four patients prescribed the combined route of PO/IV paracetamol were classified as overweight or obese; doses ranged from 18-24 mg/kg/dose. ▸ Six patients prescribed oral paracetamol on discharge were classified as overweight or obese; doses ranged from 13-33 mg/kg/dose.3. Paracetamol was prescribed as IV/PO in 32 inpatients.4. IV paracetamol was prescribed in 52 patients; 20 were not reviewed at 48 hrs for a switch to oral route. Of these, only 3 were appropriate prolonged IV prescriptions.Conclusion Audit findings showed inadequate compliance with local prescribing guidelines posing a risk of inappropriately high doses of paracetamol being prescribed to overweight and obese children. In addition, unnecessarily prolonged IV use was observed. Following feedback local guidelines were amended in 2015 to recommend that in obese children, dosing should reflect lean body mass and ideal weight for height. The maximum daily dose was also reduced to 75 mg/kg/day. Prescribers require education regarding this important issue.

Practical Challenges—Use of Paracetamol in Children and Youth Who are Overweight or Obese: A Narrative Review

“…Six studies were identified that provide data on paracetamol dosing patterns in pediatric patients who are overweight or obese. These studies included four retrospective studies conducted in Danish [ 34 ], Middle Eastern [ 35 ], Italian [ 36 ], and American populations [ 37 ], an audit of pain management prescriptions in the United Kingdom [ 38 ], and a survey and observational study of Australian caregivers and pharmacists [ 39 ]. Overall, the studies reported that dosing practices in children who were overweight or obese were variable and findings of incorrect dosing were mixed.…”

“…Three studies reported more frequent overdosing in children who were overweight or obese [ 34 , 38 , 39 ]. The retrospective cohort study conducted at the Danish Children’s Obesity clinic evaluated dosing strategies in 200 overweight or obese children aged 3–18 years from 2007 to 2015.…”

“…Among pediatric patients who were overweight or obese, six received oral paracetamol doses ranging from 17.4 to 30 mg/kg/dose; four received intravenous (IV) paracetamol doses ranging from 20 to 23 mg/kg/dose; and four received a combination of oral and IV paracetamol doses ranging from 18 to 24 mg/kg/dose. A total of six patients who were overweight or obese received oral paracetamol at discharge at doses of 13–33 mg/kg/dose [ 38 ].…”