This study clarified the effect of pharmacist‐led interventions to decrease the cost and inappropriate prescribing of parenteral paracetamol (PP). The prescribing pattern of PP was assessed at baseline and after pharmacist‐led interventions (educational and protocol interventions) in a teaching hospital in Tehran, Iran. Comparison of appropriate dosage form between baseline and postintervention assessments indicated a significant difference (55.6% vs 77.6%, respectively; p < 0.001). Educational intervention significantly improved the appropriate duration of PP administration from baseline to postintervention (29% vs 41.7%, respectively; p = 0.006), but had no significant effect on the appropriateness of dosing. The mean monthly number of vials used decreased considerably following the educational and protocol interventions (25% (p = 0.002) and 59% (p < 0.001) reductions, respectively). Thus, incorporating educational and protocol interventions could promote the appropriate prescription and rational use of PP and aid in reducing its financial burden.

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Angioplasty and stenting of the cervicocerebral arteries is a novel treatment for atherosclerotic stenosis, which has periprocedural complications. Data were collected prospectively from 2007 to 2009 in a multicenter cohort of patients undergoing interventions for cervicocerebral stenosis. Retrospective assessment of the 2003-2006 archives of the same interventionists and a review of their published work is the second part of this national survey. In 592 extracranial internal carotid artery angioplasty and stenting procedures in 581 patients (73% male; mean age, 63.4 + or - 7 years), transient ischemic attack, stroke, intracerebral hemorrhage, and death occurred in 1.7%, 1.7%, 0.34%, and 1.52%, respectively. In 114 extracranial vertebral artery angioplasty and stenting procedures in 110 patients (68% male; mean age, 65.3 + or - 6 years), transient ischemic attack and stroke each developed in 1 (0.92%) patient, but there was no intracerebral hemorrhage or death. In 70 intracranial angioplasty and stenting procedures in 67 patients (76% male; mean age, 68.5 + or - 8 years), transient ischemic attack, stroke, intracerebral hemorrhage, and death were observed in 1.4%, 8.6%, 1.4%, and 2.9%, respectively. The frequency of periprocedural complications in angioplasty and stenting of cervicocerebral arteries by our neurointerventionists was similar to that in developed countries.

BackgroundAcetaminophen is an analgesic and antipyretic agent, recommended worldwide as a firstline treatment for the management of mild to moderate pain. There is a significant cost difference between parenteral and oral/rectal preparations of acetaminophen in Iran. Additionally, intravenous (IV) administration imposes an extra preparation and nursing burden. Invasive procedure complications is another concern. Although acetaminophen relieves mild to moderate pain and has a synergistic effect with other analgesics, the IV route should only be used if the oral or rectal dosage form cannot be utilised.PurposeThe primary objective of this study was to evaluate the utilisation of IV acetaminophen and clarify the role of protocol enforcement in decreasing the cost of pharmacotherapy and progressing to rational drug usage.Material and methodsA pilot study was conducted in February 2015 to evaluate the prescribing appropriateness of IV acetaminophen. Data were obtained from a randomly selected group of 230 patients. A protocol for appropriate use of parenteral acetaminophen was designed by the pharmaceutical care department in accordance with drug monograph and reliable guidelines. The protocol was implemented in two phases: in phase one, the protocol was introduced to healthcare professionals via a newsletter, text messaging and face to face meetings with influential physicians. In the second phase, the pharmacists approved dispensing of IV acetaminophen to medical wards only if the physician’s order accompanied a signed paper protocol. The trend of IV acetaminophen utilisation was assessed during the intervention.ResultsDuring February 2015, 5139 acetaminophen injections were prescribed for 1631 patients. Inappropriate orders were revealed in 41% of the dosage forms, 38% for duration and 50% for dosages. Only in 27% of patients were all three parameters correct. Following phase one, the number of prescribed IV acetaminophen doses decreased to 3152 for 932 patients in one month (approximate 38% reduction). After the second phase, the use of acetaminophen was 2328 injections in 808 patients after protocol enforcement. The net reduction was 55% after the two phase intervention.ConclusionDevelopment and implementation of drug protocols could improve appropriate prescribing and reduce cost in hospital settings.No conflict of interest