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. Now children’s hospitals are openly sharing policies to control usage.
Keys to Progress
Here's how Valley Children's Hospital found success.
Medication Utilization Committee. A multidisciplinary team meets twice monthly for focused, evidence-based medication reviews that makes well-informed recommendations to a larger group, such as a Pharmacy and Therapeutics (P&T) Committee. This can help guide organizational decision making.
Evidenced-based usage. Identifying the drug’s specific and evidence-based uses for your patient population will inform criteria-based restriction development. Clinically relevant outcomes are assessed, not just statistically significant outcomes from published studies where the magnitude of benefit might be quite small.
Create personal accountability checkpoints. At Valley Children’s, each time IV acetaminophen is requested, physicians are required to submit a short, non-formulary request to the pharmacy clinical manager who reviews the case using the pre-defined criteria for use.
If the patient does not meet criteria, the prescriber may immediately appeal to either the chair of medication utilization or P&T Committee to review their request for use of IV acetaminophen. This creates a physician-to-physician conversation to better assess the patient’s specific circumstance and clarify appropriateness of the request without delaying patient care.