SP 5.08 IV Paracetamol in surgical patients: Drip? or Drop it?

Abstract

Intravenous paracetamol is commonly prescribed in surgical patients despite local guidelines recommending oral administration unless specific indications are met. Compared with oral, IV is 48 times more expensive and associated with up to 16 times higher carbon emissions, presenting a clear opportunity for sustainable prescribing in surgical care. This audit assessed compliance with local paracetamol guidelines in patients admitted under General surgery, evaluating educational interventions impact.

A retrospective observational audit was conducted reviewing electronic medical records and medication charts for patients admitted under General Surgery over two weeks in October 2025. Findings were presented at departmental teaching with education focused on environmental, financial and clinical benefits of oral paracetamol. An E-poster summarising guidelines was disseminated. A re-audit using the same methodology was completed for a two-week period in December 2025.

In the initial cycle, 58% of patients were prescribed IV paracetamol. Average duration of IV use was 6.8 days with an average of 16 doses per patient. Only 13% of doses were guideline appropriate. Following intervention, 61% were prescribed IV, with a mean duration of 3.3 days and average doses per patient of 7. The proportion of appropriate doses increased to 26%.

There was a reduction in duration and doses per patient of IV paracetamol, with fewer inappropriate doses administered. This demonstrated potential annual cost savings up to £4,000 and estimated annual reduction of carbon emissions up to 1 tonne in this small audit. Further audit cycles are required to assess long term behavioural changes and ensure sustainable prescribing practices.