LAUSR

literature supports the use of a dose ceiling of 10mg for both intravenous (IV) and intramuscular (IM) dosing. However, some practitioners prescribe needlessly excessive doses for pain control. The primary purpose of this study was to determine the current dosing patterns of ketorolac tromethamine, both for intravenous (IV) and intramuscular (IM) dosing, as well as to determine the amount of medication waste between ordered dose and vial size charged to the patients. Methods: The orders of any ED patient that received a dose of ketorolac between the dates of January 1, 2012 to January 1, 2017 were collected from the EPIC electronic medical record (EMR) from the emergency department (ED) at a level 1 trauma center in Dayton, Ohio. Ketorolac electronic prescribing codes (eRX) for the vial sizes of 15mg, 30mg, and 60mg were used to generate the search. The search included all ED providers, including MDs, DOs, PA-Cs, and APRNs. Dosing practices by individual provider type were analyzed. Both the ordered dose and the vial size used by the nurse were also recorded and used to calculate drug waste. Results: There was a total of 10,687 unique orders for ketorolac during the study period. There was a total excess of 492,830 mg of drug ordered above the therapeutic dose ceiling over the 5-year period. Actual drug waste between ordered dose and vial size was 9895 mg, with over 90% of orders having no waste due to high incidence of 60mg doses. PA-Cs had the highest rate of prescription of a 60 mg dose (95%), followed by DO (91%), and MD (85%) (p<0.001). Please reference table 1 for details on dosing practices by provider type. Conclusions: This study highlights that many practitioners are prescribing excessive doses of ketorolac. The ordered amount was frequently 4.6 times the necessary amount to obtain ceiling dose analgesia. These data provide an opportunity for directed education at efficient and efficacious dosing practices. Further research should focus on length of time of analgesia for each dose strength, as well as duration of fever control by dose strength.