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Nguyen et al
settings. Second, given the retrospective study design and heterogeneous patient population receiving IV APAP, we were
unable to assess the effect of IV APAP restriction on LOS.
Third, the balancing measures of IV opioid and NSAIDs consumption were confounded by other efforts within the institution that may have directly impacted these measures. The
difficulty in finding pure balancing measures, unaffected by
other changes in complex healthcare systems, remains a challenging dilemma for QI projects. Similarly to a previous study
on formulary management of IV APAP,30 pain scores were not
evaluated due the limitations of obtaining reliable and consistent data retrospectively from the EMR. However, use of balancing measures assessing consumption of other analgesics
was used to mitigate this limitation. Prospective, randomized
controlled trials on specific patient populations with appropriate comparison groups are needed to determine whether IV
APAP provides benefit in regard to length of stay, pain reduction, and opioid consumption for specific patient populations.

Conclusion
Through an iterative process, using QI methodology, we demonstrated the ability to restrict IV APAP in a manner that
resulted in considerable cost savings to the institution, while
at the same time allowing the medication to be used for indicated purposes. Keys to our success included the involvement
of a multidisciplinary, interprofessional P&T committee, continuous resource reviews, refinement of restriction criteria via
PDSA methodology, enhanced EMR design, and empowerment of pharmacists to be gatekeepers. These results reinforce the importance of expanding the scope of P&T
committees to include continuous QI initiatives.
Acknowledgments
The authors acknowledge Yen Pham, RPh, Mike Bonazzollo, MD,
FACP, and Rebecca Britton, PharmD, and the members of the
Clinical Knowledge and Therapeutics Executive Committee and
reporting committees and subcommittees whose hard work and dedication contributed to the success of this project. Acknowledgment
to Ken Pickron for assisting with data collection.

Declaration of Conflicting Interests
The author(s) declared no potential conflicts of interest with respect
to the research, authorship, and/or publication of this article.

Funding
The author(s) received no financial support for the research, authorship, and/or publication of this article.

Ethical Considerations
The study was deemed nonhuman subjects research by the Oregon
Health & Science University Institutional Review Board
(IRB#00018143).

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Hospital Pharmacy - August 2020

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