Title : Sustainable prescribing- using oral paracetamol in the perioperative period
Abstract:
Background: Sustainable healthcare is increasingly important in reducing the environmental impact of medical intervention. In perioperative medicine, intravenous (IV) drug administration contributes significantly to single-use plastic waste and higher costs compared to oral (PO) alternatives. IV paracetamol is commonly used for analgesia despite evidence suggesting comparable efficacy of PO paracetamol. This quality improvement project aimed to evaluate the sustainability and cost-effectiveness of switching from IV to PO paracetamol in the perioperative setting.
Objective: To assess the impact of encouraging the use of PO paracetamol over IV in perioperative pain management, focusing on cost savings and reduction in IV-related plastic waste.
Methodology: A two-cycle audit of 30 days was conducted within a single surgical department at a tertiary orthopaedic centre, identifying IV and PO paracetamol administration rates, plastic use and cost. An intervention was implemented encouraging perioperative staff (anaesthetists, surgeons, theatre and ward nurses) to prescribe PO paracetamol pre-operatively instead of IV, where clinically appropriate. Data on the total number of patients receiving IV and PO paracetamol were compared pre- and post-intervention, including identifying differences in cost and plastic waste.
Results: Pre-intervention, 44/47 patients (93.6%) received IV paracetamol, incurring a cost of £152.68 and generating 2.77kg of plastic waste. Post-intervention, the proportion of patients receiving IV paracetamol significantly decreased to 10/60 (16.7%), generating only 630g of plastic waste. 53/60 patients (88.3%) received PO paracetamol, highlighting a substantial shift in prescribing practice. This change was associated with a significant cost reduction, to a total of £35.23. By reducing IV paracetamol usage, the intervention successfully lowered plastic waste production by 2.14kg.
Conclusions: The intervention demonstrated a positive shift towards sustainable prescribing, improving both cost-effectiveness and environmental impact without compromising patient care. This QIP demonstrates that a targeted intervention encouraging PO administration can lead to meaningful reductions in IV usage, lowering both costs and plastic waste. Wider implementation of sustainable prescribing across other surgical units can enhance environmentally sound and cost effective practice.
