ThP5.14 - Assessing Adherence and Cost Implications of NICE Guidelines for Intravenous compared to Oral paracetamol use after Resuming Oral Diet Following Liver and Pancreas Resections

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Abstract Aim For post-operative pain management NICE recommends not to offer intravenous paracetamol unless the person cannot take oral medicine [NG180] 1.6.6. Despite this recommendation, many patients continue to receive intravenous paracetamol whilst on oral diet. This audit aims to assess the adherence and cost implications of NICE guidelines for switching from IV to oral paracetamol once oral diet resumes following liver and pancreas resections. Method Data for 176 patients undergoing major liver or pancreas resections at the Royal Free Hospital London (January 2022 to October 2023) was collected retrospectively. This included the number of IV and oral paracetamol doses, resumption of oral diet post-operatively, and the total number of IV paracetamol doses whilst oral diet resumed. Costings for IV and oral paracetamol were established, and the total cost was calculated per patient. After a departmental presentation, the audit cycle was completed. Result The analysis of the initial dataset disclosed that 69% of patients were administered IV paracetamol while on an oral diet, incurring a cost of £9412/100 patients, in contrast to £18.5 for oral paracetamol. Following the intervention, there was a noteworthy enhancement in adherence to guidelines, reducing the average days of IV paracetamol administration after resuming oral diet from 4.08 days pre-intervention to 2.06 days post-intervention. Conclusion This improved adherence showed almost 50% cost reduction compared to first audit. In addition to this we can also expect early patient mobilization, enhanced recovery, and prompt discharges. This audit provides valuable insight into optimizing postoperative pain management strategies and resource utilization.