Compliance with paracetamol prescribing policies at a Sydney Hospital

Abstract

Background: Despite being marketed as a safe non‐opioid analgesic there are concerns about paracetamol's potential to cause hepatotoxicity. The NSW Health paracetamol policy mandates review of all hospital inpatient orders 48 hours after starting paracetamol and dose reduction for older patients. Aim: To assess hospital staff's knowledge and attitude of and their compliance with the NSW Health paracetamol policy and the complementary hospital paracetamol guideline. Methods: A cross‐sectional audit of 14 wards at a 560‐bed hospital was conducted over one week to evaluate compliance with the NSW Health and the hospital paracetamol guidelines. An anonymous questionnaire was used to assess the hospital staff's awareness of these guidelines. Results: 274 patients were eligible to participate in the audit. Most patients (n = 196; 75%) were prescribed paracetamol with regular paracetamol the most common prescription. Patients prescribed paracetamol were less likely to have their liver function tests measured than patients not prescribed paracetamol. Most (73%) patients aged 65 years and over were prescribed reduced doses of paracetamol (less than 4 g/day) in accordance with the NSW Health and the hospital guidelines. Hospital staff's awareness of these guidelines was low and was highest among pharmacy staff. Conclusion: Compliance with and knowledge of the NSW Health and hospital paracetamol guidelines were limited and varied between hospital staff. Innovative methods for dissemination of information crucial for safe and efficacious use of medicines are required.