Could a simple painkiller change the world? Swansea Bay clinicians are proving that it can, with a groundbreaking project that is not only better for patients but also for our planet. Imagine a world where healthcare actively reduces its environmental footprint while simultaneously saving money – this project brings us closer to that reality.
Pictured: Consultant Anaesthetists Rebeca Harris and Tereza Soskova, alongside Senior Clinical Fellow Lara Sabry, are leading the charge in this innovative initiative.
The core of their work revolves around a seemingly simple question: how do we best administer paracetamol to young patients undergoing planned surgery? Their research has revealed significant differences between giving children paracetamol orally (as a liquid or tablet) versus intravenously (through a vein), with implications that extend far beyond just pain relief.
Previously, the standard practice at Morriston Hospital involved administering paracetamol intravenously to pediatric patients once they were under general anesthesia. But the IMPROVE (Improving Paracetamol use with Routine Oral over Venous administration) project team, led by Consultant Anaesthetists Tereza Soskova, Rebeca Harris, and Alex Morgan, along with Senior Clinical Fellow Lara Sabry and Core Trainee doctor Linn Jarte, challenged this norm. They discovered that oral paracetamol, given before anesthesia, provided the same level of pain relief upon waking as the intravenous method. But here's where it gets controversial… while the pain relief was comparable, the cost and environmental impact were anything but.
Pictured: Dedicated staff from the Children's Ward played a vital role in the success of this project.
Oral paracetamol costs mere pennies, while the manufacturing and administration of the IV version carry a significantly larger environmental burden. The team calculated that by switching to oral paracetamol for pediatric planned surgeries, the NHS could avoid the environmental impact equivalent to driving over 23,000 miles per year! And this is the part most people miss: these savings don't compromise patient care. According to Dr. Soskova, "In terms of patient impact, there’s no difference in either safety or analgesic efficacy between IV or oral."
Let's break down the numbers. Dr. Soskova points out a staggering 98.3% cost savings by using oral paracetamol. Initial calculations revealed IV paracetamol to be a whopping 24 times more expensive than oral tablets. Furthermore, IV paracetamol results in up to 12 times higher carbon emissions than its oral counterpart. "That has changed our view on paracetamol usage, and we are looking to switch to a 90 percent oral usage rate," Dr. Soskova explained.
The initial data from 2024 showed that 90% of paracetamol administration to over 1,300 pediatric patients was intravenous. Had oral administration been used instead, a remarkable 9,190kg of eCO2 could have been saved – equivalent to driving 23,403 miles in a petrol car. The cost savings would have amounted to £1,150.
Why is this so important? Dr. Soskova references a British Journal of Anaesthesia (BJA) paper that highlights the significant environmental impact of healthcare. "They mention that healthcare is responsible for five percent of greenhouse gas emissions globally – so our profession makes up a significant part of the problem," she stated. "Of this, pharmaceuticals make up 19-32 percent. Paracetamol is one of the most commonly used medications – it makes up six percent of all pharmaceutical sales worldwide. So we wanted to look at the impact we are making in Swansea Bay, and that led to this project."
But the story doesn’t end there. The team is now exploring expanding the project to include planned adult surgeries across Morriston, Singleton, and Neath Port Talbot hospitals. With a larger patient base, the potential for financial and environmental savings is even more substantial. This expansion could radically change how hospitals approach medication, minimizing environmental impact and reducing costs without compromising patient well-being.
Here's a thought-provoking question: If a simple change in how we administer paracetamol can have such a significant impact, what other common medical practices are ripe for similar environmentally conscious and cost-effective improvements? Could this project serve as a blueprint for other hospitals and healthcare systems worldwide? Share your thoughts and comments below! Do you agree with the team's findings? Are there potential drawbacks to switching to oral paracetamol that need to be considered? Let's discuss.
