Optimising Paracetamol Prescribing for Safer, Greener, and Cost-Effective Care: Lessons From an Ongoing Emergency Department Quality Improvement Project.

Paracetamol is one of the most frequently prescribed analgesics in emergency departments (EDs). While intravenous (IV) and oral formulations provide similar analgesic effects, IV paracetamol is more expensive and has a carbon footprint several-fold higher than oral administration. In patients who can take oral medication, the oral route is safer, greener, and more cost-effective. At Royal Preston Hospital in Preston, UK, the baseline audit data from December 2022 to November 2023 revealed that IV paracetamol accounted for approximately 38% of all 1 g paracetamol doses prescribed in the ED. Following informal teaching sessions and staff engagement, a re-audit from February to April 2024 demonstrated no significant reduction in IV use. A further audit from May 2024 to March 2025 revealed no significant reduction in IV paracetamol use, with prescribing rates continuing to hover around 35% to 40% across most months. These findings highlight that early educational interventions can influence prescribing behavior but may be insufficient to deliver lasting change. To build on this work, a structured quality improvement (QI) approach was adopted to implement more targeted and sustainable interventions, including formal teaching, visual prompts, and regular feedback cycles. By encouraging appropriate use of oral paracetamol, this project aims to reduce unnecessary IV prescribing while improving patient safety, lowering costs, and contributing to environmentally sustainable practice. Importantly, this remains an ongoing, multi-cycle initiative, with a third round of data collection commencing in August 2025. This QI report aims not only to outline the effectiveness and sustainability impact of optimizing paracetamol prescribing but also to demonstrate how similar projects can be replicated across various other healthcare departments worldwide. Such initiatives have the potential to promote safer, greener, and more cost-effective care with global relevance.