Paracetamol overdosing in a tertiary care hospital: implementation and outcome analysis of a preventive alert programme

Niedrig, David F.; Bucklar, Guido; Fetzer, Mike; Mächler, Sarah; Gött, Carmen; Russmann, Stefan

doi:10.1111/jcpt.12427

Cited by 5 publications

(4 citation statements)

References 12 publications

(19 reference statements)

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“…The main reason found for overdose > 4 g/day was a switch from one application route to another without considering the time of last administration. This is in accordance to another Swiss study looking at paracetamol overdosing in hospital setting [ 12 ]. Accordingly, overdosing was in the majority of cases a single day event and happened rarely on consecutive days.…”

Section: Discussionsupporting

confidence: 93%

“…An earlier study conducted in a Swiss university hospital using the same CIS analyzed the efficacy of a similar alert system combining automated detection with subsequent expert validation. They reported absolute overdosing (> 5 g/day) in 0.4% of patients, 91.3% of which were detected by the alert e-agent [ 12 ]. The diagnostic accuracy of the e-agent in this study was lower, but (in contrast to this one) their system did not look for relative overdosing or short intervals.…”

Section: Discussionmentioning

confidence: 99%

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Implementation and outcome of an electronic tool for detection of paracetamol overdose in a tertiary care hospital

et al. 2020

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Background Paracetamol is a widely used analgesic and antipyretic drug in hospitals. The development and implementation of an electronic tool with algorithm-based alerts (e-agent) in a clinical information system could reduce the risk of overdose. Objective In this study, the performance of such an e-agent developed to detect paracetamol overdosing was analyzed. Setting Swiss tertiary care hospital. Method All patients ≥ 18 years old who had documented paracetamol administration in the used clinical information system during 2017 were retrospectively screened for an absolute and relative overdosing of paracetamol (> 4 g and > 60 mg/kg/24 h, respectively). This was compared with the patients for which the e-agent had, during the same period, prospectively made an alert for absolute or relative overdosing or for a dosing interval < 4 h (potentially leading to an absolute overdose). Main outcome measure E-agent performance defined as detection rate. Results of the 13,196 adult patients who received at least one dose of paracetamol, 2292 were exposed at least once to > 4 g/day (17.4%), 39 of these (0.3% of total) were given > 5 g paracetamol. None received more than 6 g. The e-agent detected 87.2% of cases with doses > 5 g. In most cases (87.9%), the cause of the absolute overdose was a switch from intravenous to oral paracetamol, resulting in an absolute overdose the day of the change. The maximal daily dose of 60 mg/kg was exceeded in 30.1% of patients weighing < 50 kg, as well as in 42.3% of patients weighing < 60 kg. The e-agent detected 73.4% and 75.5% of those cases. Multiple absolute overdoses were found in 204 patients. The e-agent detected 72.7% of those. 90 multiple overdoses occurred during the same hospital stay and 11 on consecutive days. Conclusion Paracetamol overdose is a common medication error in hospitalized patients, which may occur due to process failures such as wrong timing when changing administration route or when factors like comedication and low body weight are ignored. The e-agent detects cases of paracetamol overdose, and therefore, can help prevent this kind of medication error in the clinical setting.

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Section: Discussionsupporting

confidence: 93%

Section: Discussionmentioning

confidence: 99%

Implementation and outcome of an electronic tool for detection of paracetamol overdose in a tertiary care hospital

et al. 2020

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“…2,16,17 Furthermore, unintentional paracetamol overdosing is a common medication error in hospitals. 16,18 Internationally, concerns have been raised about potentially excessive paracetamol dosing in frail older and low-weight individuals. 13,19 For example, England's Healthcare Safety Investigation Branch, an organisation responsible for the investigating patient safety concerns, is conducting an investigation titled Unintentional overdose of paracetamol in adults with low body weight.…”

Section: Introductionmentioning

confidence: 99%

“…Studies from the UK and Australia indicate that the prevalence of paracetamol use in hospital patients is high (62–72% patients) 2,16,17 . Furthermore, unintentional paracetamol overdosing is a common medication error in hospitals 16,18 . Internationally, concerns have been raised about potentially excessive paracetamol dosing in frail older and low‐weight individuals 13,19 .…”

Section: Introductionmentioning

confidence: 99%

Paracetamol dosing in hospital and on discharge for older people who are frail or have low body weight

Elliott

2022

Brit J Clinical Pharma

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Aims To describe paracetamol dosing and liver function test (LFT) monitoring in older hospital inpatients who are frail or have low body weight. Methods Retrospective observational study, at a 790‐bed metropolitan public health service in Australia. Patients aged ≥70 years, with body weight <50 kg or frailty index based on laboratory data (FI‐Lab) score ≥0.3, who were administered paracetamol during an admission with length‐of‐stay >72 hours, were included. Data were extracted from electronic medical records. Paracetamol doses administered in hospital, and doses prescribed on discharge, were compared against consensus guidelines that recommended ≤60 mg/kg/d for older people weighing <50 kg, and ≤3000 mg/d for frail older people. Results In total, 240 admissions (n = 229 patients, mean age 84.7 years) were analysed. During 150 (62.5%) admissions, higher than recommended paracetamol doses were prescribed. On 138 (57.5%) occasions, patients were prescribed paracetamol on discharge, and 112/138 (81.2%) doses were higher than recommended. Most discharge prescriptions (97/138, 70.3%) were for regular administration. The median daily dose on discharge for patients <50 kg was 83.7 mg/kg (interquartile range 73.6–90.9 mg/kg). For frail patients ≥50 kg, the median daily discharge dose was 3990 mg (interquartile range 3000–4000 mg). LFTs were measured in hospital for 151/200 (75.5%) and 93/166 (56.0%) patients who received paracetamol for >48 hours and >5 days, respectively. Conclusion Majority of paracetamol doses prescribed for frail or low‐weight older patients in hospital and on discharge were higher than recommended in consensus guidelines. LFTs were not measured for 44% patients who received paracetamol regularly for >5 days. Further studies are needed to explore long‐term outcomes of this practice.

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The effects of colostrum on some biochemical parameters in the experimental intoxication of rats with paracetamol

Karabacak

Kanbur

Eraslan

et al. 2018

Environ Sci Pollut Res

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In the current study, the possible prophylactic and therapeutic effects of colostrum (COL) on acute organ injury caused by paracetamol (PAR) in rats were evaluated. Within the scope of this study, a 2-month-old male (150-200 g) 70 Wistar Albino rat was used and a total of seven groups were designed. The first group (CNT) was maintained for control purposes. The second group (COL-1) was given COL for 1 day, at a dose of 500 mg/kg at 6-h intervals, and blood and tissue sampling was performed at 24 h. The third group (COL-7) received COL for 7 days, at a dose of 500 mg/kg at 6-h intervals on day 1 and at a daily dose of 500 mg/kg on the following days, and blood and tissue samples were taken at the end of seventh day. The fourth group (PAR-1) was administered with PAR at a dose of 1.0 g/kg bw and was blood and tissue sampled at 24 h. The fifth group (PAR-7) received PAR at a dose of 1.0 g/kg bw on day 1 and was blood and tissue was removed at the end of day 7. The sixth group (PAR+COL-1) was administered with a combination of PAR (1 g/kg bw) and COL (500 mg/kg at 6-h intervals), and blood and tissue samples were collected at 24 h. The seventh group (PAR+COL-7) received 1.0 g/kg bw of PAR on day 1 and was given COL throughout the 7-day study period (at a dose of 500 mg/kg at 6-h intervals on day 1 and at a daily dose of 500 mg/kg on the following days). In the seventh group, blood and tissue samples were taken at the end of seventh day. Alkaline phosphatase (ALP), alanine aminotransferase (ALT), aspartate aminotransferase (AST), blood urea nitrogen (BUN), glucose, creatinine, triglyceride, total bilirubin, total protein and albumin levels/activities were analysed in the serum samples. The malondialdehyde (MDA), nitric oxide (NO), superoxide dismutase (SOD), catalase (CAT) and glutathione peroxidase (GSH-Px) levels/activities, known as oxidative stress parameters, were assayed for tissue homogenates and blood (erythrocytes/plasma); in addition, enzyme activities of GSH S-transferase (GST), cytochrome P4502E1 (CYP2E1), NADH-cytochrome b5 reductase (CYTB5), glucose-6-phosphate dehydrogenase (G6PD), NADPH-cytochrome P450 C reductase (CYTC) and glutathione (GSH) levels/activities defined as drug metabolising parameters were measured in liver homogenates. In result, it was determined that PAR caused significant alterations in some biochemical and lipid peroxidation parameters and the activities/levels of drug metabolising parameters in the liver and that COL normalised some of these parameters and reduced PAR-induced tissue damage.

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Paracetamol overdosing in a tertiary care hospital: implementation and outcome analysis of a preventive alert programme

Cited by 5 publications

References 12 publications

Implementation and outcome of an electronic tool for detection of paracetamol overdose in a tertiary care hospital

Implementation and outcome of an electronic tool for detection of paracetamol overdose in a tertiary care hospital

Paracetamol dosing in hospital and on discharge for older people who are frail or have low body weight

The effects of colostrum on some biochemical parameters in the experimental intoxication of rats with paracetamol

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