• Katelyn A Howell, Cassandra A Ruggles, Marlene Thompson, Kelly Z Metzger, Jean A Christopher, and Michael T Bigham.
• All authors: Children's Hospital Medical Center of Akron, Akron, OH.
• Pediatr Crit Care Me. 2020 Jun 1; 21 (6): 550-556.

ObjectivesImprove medication-related variable ICU costs by increasing value related to a locally identified high-frequency/high-cost medication, IV acetaminophen.DesignStructured quality improvement initiative using the Institute for Healthcare Improvement's Model for Improvement.SettingTwenty-three-bed tertiary PICU.PatientsAll patients admitted to the PICU receiving IV acetaminophen during the study period of 2015-2018.InterventionsPICU staff survey, education to close nurse/provider knowledge gap, optimization of order sets and electronic health record order entry, improving oral/enteral medication transition, and optimization of pharmacy dispensing.Measurements And Main ResultsThe primary outcome of interest was IV acetaminophen doses per patient day reported as a 12-month rolling average. Baseline IV acetaminophen prescribing prior to the study period was initially 0.55 doses per patient day, and in 2014, there were 3,042 doses administered. IV acetaminophen is $43 per dose. The rolling 12-month average post intervention was 0.33 doses per patient day. Enteral and rectal doses increased from 0.42 to 0.58 doses per patient day. Opioid utilization varied throughout the study. A 40% reduction in IV acetaminophen equated to a $35,507 cost savings in a single year.ConclusionsIV acetaminophen is prescribed with high frequency and impacts variable PICU costs. Value can be improved by optimizing IV acetaminophen prescribing.

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