BackgroundIrrational use of medicines is a widespread problem in healthcare and imposes huge costs on health systems.PurposeTo promote rational drug prescription and expenditure, we performed a study on albumin and pantoprazole expenditure in our hospital.Material and methodsA cross sectional study was conducted to examine the role of a restrictive protocol on intravenous pantoprazole and albumin consumption. The protocol was designed by clinical pharmacists and after approval by a drug and therapeutics committee, was presented to hospital wards. The pharmacists from the hospital pharmacy approved dispensing of pantoprazole and albumin to medical wards only if the physician’s order accompanied a signed paper protocol and the prescription conformed to the protocol. Otherwise, the pharmacist consulted with the physician to prescribe appropriate alternatives. The average consumption and cost of albumin and pantoprazole were analysed, comparing 3 months before with 3 months after protocol enforcement. The average number of consumed vials per month and related expenditure were obtained from the hospital information system.ResultsThe average monthly consumption of albumin was 1832 vials before and 858 vials after the intervention. The mean albumin cost per hospital bed day was $2.6 before and $1.5 after the intervention, leading to a cost difference of about $1.1 per hospital bed day with a mean monthly saving of about $29 751 (43% decline in albumin expenditure). The mean monthly consumption of intravenous pantoprazole was 6043 vials before and 4713 vials after the intervention. The mean expenses per hospital bed day was $7.6 before and $6.2 after implementing the intervention. The protocol successfully decreased pantoprazole consumption by $1.4 per hospital bed day with a mean monthly saving of about $38 803. (Approximately 19% reduction in monthly pantoprazole expenditure.)ConclusionOur study confirms that our protocol may substantially reduce albumin and pantoprazole use and lead to significant cost savings.No conflict of interest

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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