Reducing Paracetamol Co-Prescribing with Strong Opioids on the Sheffield Macmillan Unit for Palliative Care

Hi everyone,

Highlighting this SusQI case study from 2024 which I’m sure will be relevant to many oncology inpatient wards. The team at the Sheffield Macmillan Unit for Palliative Care — an 18-bedded inpatient unit — noticed that patients on strong opioids were routinely being co-prescribed regular paracetamol, despite evidence that paracetamol adds little analgesic benefit once patients are already on strong opioids. 

The intervention was simple: on admission, the team reviewed medications jointly with patients and considered switching paracetamol from regular to "as required" prescribing — reducing the medication burden without compromising pain control. They ran brief education sessions and put up a poster showing the cumulative time and cost of paracetamol administration to encourage both prescribers and nurses to reconsider. 

The results were striking. Before the project, 55% of patients were on regular paracetamol. By the end, this had fallen to 19% — a 36% reduction. Of the 19 patients switched to as-required paracetamol, only six doses were actually taken over a two-week period, compared with the 1,058 doses that would have been administered had regular prescribing continued. Crucially, no patient who was switched to as-required paracetamol had their regular dose reinstated during the project period.

Full details are here: https://networks.sustainablehealthcare.org.uk/resources/reducing-parace…