Paracetamol is a commonly used analgesic in older adults. There have been reports of adverse events with chronic paracetamol use even at therapeutic doses. The objective of this quality improvement activity (QIA) was to evaluate the prevalence of inappropriate paracetamol prescription in the elderly admitted for falls and to introduce strategies to reduce the rates of inappropriate paracetamol prescription in this population.
As a part of QIA, an audit was performed on 100 patients aged 75 years and older who were admitted to the Geriatric Medicine department of a tertiary hospital in Singapore between July 2019 and October 2019 with a primary diagnosis of a fall. Data collected included demographic data, relevant medical history of cirrhosis, cognitive impairment, alcohol use and weight <50kg, prescription pattern of paracetamol on day 1 or 2 of admission and on discharge as well as clinical data on the documented indications for paracetamol use.
Paracetamol was prescribed in 84 patients. Out of these 84 patients, 56 were prescribed round-the-clock paracetamol with a median duration of 9 (IQR=10) days. In this group, paracetamol use was inappropriate in 32 (57%) of them and 32 (57%) patients were discharged with round-the-clock paracetamol for a median duration of 17.5 (IQR=46) days.
This QIA revealed a high prevalence of round-the-clock and inappropriate paracetamol prescription in elderly patients admitted for a fall. Moving forward, the implementation of an algorithm for paracetamol prescription hopes to reduce the rates of inappropriate paracetamol prescribing patterns in this population.
Angela Frances Yap Hui Wen, Singhealth Residency Programme, Singapore
Trisphal Kaur Dhaliwal, Singhealth Residency Programme, Singapore
Surendra Doraiswamy Varman, Changi General Hospital, Singapore