1. Evaluation of intravenous acetaminophen use in a large community hospital Andrew R. Mameli, Pharm.D. Candidate, Nicholas L. Massie, Pharm.D., Richard L. Cramer, Pharm.D., FASHP, Kurt A. Wargo, Pharm.D., BCPS AQ-ID Auburn University Harrison School of Pharmacy - Auburn, Alabama Introduction / Background Results Materials and Methods Conclusions Disclosure This medication use evaluation in an 881 bed hospital in Huntsville, Alabama included patients: Over 19 years of age who underwent a surgical procedure Receiving ≥ 1 dose of IV acetaminophen for pain control in combination with injectable opioids Similar surgical patients only receiving injectable opioids for pain control 1:1 experimental to control group ratio Data was collected for 4 days after the surgical procedure was completed Electronic chart reviews were completed, and the following data was collected: type of surgery, overall opioid consumption in morphine equivalents, opioid related adverse events and pain control scores. Opioid use was collected via PCA utilization history and charted opioids, adverse events through charted naloxone, diphenhydramine and laxatives, and pain control scores via documented nurses pain scores on a scale of 1-10. Authors of this presentation have the following to disclose concerning financial or personal relationships with commercial entities that may have a direct or indirect interest in the subject of this presentation: Andrew Mameli/Nicholas Massie/Richard Cramer/Kurt Wargo: Nothing to disclose Anti-nausea medication use: 63% in the experimental group 55% in the control group Laxative medication use: 5% in the experimental group 20% in the control group Diphenhydramine use: 26% in the experimental group 20% in the control group Naloxone was not required for opioid overdose in either group Evaluate patients receiving IV acetaminophen compared to patients receiving only opioids for perioperative pain control. The following data was collected: Total injectable opioid use PCA opioid use Pain control scores Opioid related adverse effects Objectives Results Intravenous acetaminophen use in mild to moderate perioperative pain has been shown to reduce overall opioid consumption. Huntsville Hospital approved intravenous acetaminophen for certain ICU and oncology patients and per protocol use in post colorectal surgery patients. Physician prescribing of intravenous acetaminophen to general and abdominal surgery patients beyond the approved indication increases total drug cost. Therefore, we performed a medication use evaluation to assess the use of intravenous acetaminophen. A total of 19 patients comprised the experimental group, and 20 in the control group Abdominal surgery composed 80% of the population with spinal, orthopedic and a dermatologic procedure comprising the rest One-time intra-operative doses of IV acetaminophen were given to 95% of the experimental group Average IV acetaminophen dose was 6052 mg per patient over 4 days in the experimental group Preliminary analysis suggests that intravenous acetaminophen use failed to reduce opioid consumption, reduce pain scale scores, and adverse effects, compared to opioids alone for perioperative pain control. Continuation of this study is in progress with inclusion of more patients and further analysis of the data. Approval beyond the existing Huntsville Hospital P & T Committee measures would not be recommended based on these results. Post-operative dayAverage opioid consumption in morphine equivalents per patient (mg) Average pain scale scores per patient (0-10) ControlExperimentalControlExperimental 141.853.43.33.7 230.235.73.52.6 325.725.33.73.3 417.420.23.54.4 Overall average/day28.833.73.5 Table 1: Average opioid consumption and pain scale scores in perioperative patients divided into post-operative days 1 through 4