• Case Study
  • November 21, 2019

Creating A High-Cost Drug Use Policy That Puts Patients First

IV acetaminophen may be putting children at risk.

National attention on opioid use is putting pressure on children’s hospitals to find pain management alternatives. Intravenous (IV) acetaminophen may be presented as a safer option for pediatric patients, which resonates with providers focused on safe care. However, it’s been identified as a potential risk for children, and comes at a cost that’s more than 676 times greater than the oral tablets.1 Now children’s hospitals are openly sharing policies to control usage.

Risks to pediatric patients and hospitals

Vial size. Pediatric nurses are trained on smaller dose protocols for children, yet IV acetaminophen only comes in an adult-oriented 1000mg/100ml presentation. Vial size is an issue for other highcost drugs as well, and remaining medication is typically wasted after a small dose has been given.

Overdose potential. A large vial increases the chances for overdosing a child or infant each time it is sent to the floor for administration.

Unknown toxicity. IV acetaminophen has different pharmacokinetic properties than the oral product. This includes a shorter time to peak concentration, and a bypass of the first pass effect. Studies on adult patients have shown IV acetaminophen works slightly faster compared with other routes, but no research has been done on children. A nomogram doesn’t exist for IV acetaminophen, as it does for its oral counterpart, which leaves clinicians without clear guidance on how to treat a potential overdose.

High cost and waste. Children’s hospitals currently spend more than $25 million annually on IV acetomaminophen. Because most pediatric doses are much smaller than the commercially available 1000mg single dose vial, children’s hospitals only use approximately $7 million—about 25 percent—of the product they purchase.