Switching from IV to oral paracetamol
Photo: Centre for Sustainable Medicine, National University of Singapore, Singapore
Needle Nudger (>0.5 tCO₂e or <1 tCO₂e per primary practice)Paracetamol is used for pain management after surgery. Intravenous paracetamol has 12x the lifetime carbon emissions compared to the oral form.
Utilizing oral paracetamol is safe and cost-saving. Reserve intravenous paracetamol for patients designated NPO or those that cannot tolerate oral intake. There is no difference in the safety or analgesic effect between oral and intravenous paracetamol.
This solution is featured by Choosing Wisely Canada
“Don’t prescribe intravenous (IV) antibiotics for patients who can safely be treated with an oral option, given that IV antibiotics have a higher carbon footprint.”
There is emerging evidence that conditions traditionally treated with prolonged courses of IV antibiotics, such as osteomyelitis or infective endocarditis, can safely be treated with PO antibiotics after a lead in period of IV therapy. Studies from the UK estimated that oral antibiotics have a carbon footprint up to 90% lower than the IV equivalent, depending on the antibiotic – a one-week course of oral ciprofloxacin is associated with 1.4kg CO2e (6.8km by car) of emissions versus 100.1kg CO2e (485.9km by car) for intravenous ciprofloxacin. The same group ran an early oral antimicrobial step-down project which saved 300,000 British pounds (or ~$450,000 CAD) annually. Among patients on IV antibiotics, early transition to oral antibiotics has the additional co-benefits of reducing hospital length of stay, length of treatment, nursing care needs, in addition to lowering carbon footprint. *All kgCO2e to km conversions in these recommendations are based on a carbon footprint conversion factor of 206gCO2e/km for the average Canadian vehicle in 2017. From: International Energy Agency. Fuel Economy in Major Car Markets: Technology and Policy Drivers 2005-2017. March 2019.