P450 Addressing overprescribing: lessons learned from the pabrinex shortage and its impact on practice across the North East

Introduction Prescribing outside of recognised clinical guidance is common in the NHS. Whilst this is appropriate in some scenarios, it can be due to lack of guideline awareness and/or defensive overprescribing. Prior to a national shortage in 2024 (which resulted in trusts updating guidelines to reduce overall usage and prioritise stock for high risk patients) many audits demonstrated that Pabrinex prescribing did not adhere to local or national clinical guidelines. The aims of this project were to assess regional adherence to national Pabrinex prescribing guidelines, to examine the impact of the shortage on prescribing practices, pharmacy guidelines and patient outcomes, and to estimate the potential financial impact of inappropriate Pabrinex prescribing.Methods Via our regional trainee research network, a two-stage retrospective audit was completed in eight North East hospitals, preceded by a prior pilot audit. The audit standards were based on national guidelines including BNF for Pabrinex, NICE Alcohol-use disorders: diagnosis and management of physical complications clinical guideline from 2017 and BSG Pabrinex shortage and guidance on alternatives. Audit cycles were completed pre and post local guideline changes in response to the Pabrinex shortage. We collected the amount of Pabrinex prescribed and given, if there was concern the patient may have Wernicke’s encephalopathy, if patient was on the correct dose as per the guidelines and if there was concern of Wernicke’s encephalopathy within a month.Results 853 patients were included (437 pre-shortage and 416 post-shortage). The Pabrinex shortage led to guideline changes in all included trusts. There was an overall 66% reduction in Pabrinex administration and a 38% increase in patients prescribed the correct recommended dose. This did not correspond with an increase in adverse patient outcomes. We estimated that this resulted in a £17,187 saving over four weeks across eight hospitals based on the raw drug cost and the associated equipment to administer and deliver the Pabrinex.Conclusion These results show that prior to the national shortage, Pabrinex was commonly not prescribed according to guidelines. The shortage led to raised awareness and more stringent prescribing, which did not correspond with adverse patient outcomes. Significant cost and time savings are likely to have been made. This highlights that evidence-based prescribing can safely reduce unnecessary treatment while delivering significant financial and workforce efficiencies.