Is prescribing paracetamol 'pro re nata' acceptable?

The aim of this study was to assess the prescribing pattern of paracetamol in a children's department of a general hospital. A retrospective audit of the case record prescriptions revealed that 190 of a sample of 299 children had received paracetamol during their inpatient stay. The major indications for paracetamol use were fever associated with infection in medical patients and pain following minor surgical procedures. The most common regimen was 4 hourly p.r.n. and this had the greatest potential to lead to a dose in excess of 90 mg/kg per 24 h, other than the actual prescribing of high doses on a fixed basis. This dose was actually administered to 13.6% of the children, and was prescribed for 74% of the group. We conclude that a p.r.n. regimen can lead to overdose and this may be potentially hazardous for children.