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 6 publications

(4 citation statements)

References 12 publications

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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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Evaluating EHR-Integrated Digital Technologies for Medication-Related Outcomes and Health Equity in Hospitalised Adults: A Scoping Review

Murthi,

Martini,

Falconer

et al. 2024

J Med Syst

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The purpose of this scoping review is to identify and evaluate studies that examine the effectiveness and implementation strategies of Electronic Health Record (EHR)-integrated digital technologies aimed at improving medication-related outcomes and promoting health equity among hospitalised adults. Using the Consolidated Framework for Implementation Research (CFIR), the implementation methods and outcomes of the studies were evaluated, as was the assessment of methodological quality and risk of bias. Searches through Medline, Embase, Web of Science, and CINAHL Plus yielded 23 relevant studies from 1,232 abstracts, spanning 11 countries and from 2008 to 2022, with varied research designs. Integrated digital tools such as alert systems, clinical decision support systems, predictive analytics, risk assessment, and real-time screening and surveillance within EHRs demonstrated potential in reducing medication errors, adverse events, and inappropriate medication use, particularly in older patients. Challenges include alert fatigue, clinician acceptance, workflow integration, cost, data integrity, interoperability, and the potential for algorithmic bias, with a call for long-term and ongoing monitoring of patient safety and health equity outcomes. This review, guided by the CFIR framework, highlights the importance of designing health technology based on evidence and user-centred practices. Quality assessments identified eligibility and representativeness issues that affected the reliability and generalisability of the findings. This review also highlights a critical research gap on whether EHR-integrated digital tools can address or worsen health inequities among hospitalised patients. Recognising the growing role of Artificial Intelligence (AI) and Machine Learning (ML), this review calls for further research on its influence on medication management and health equity through integration of EHR and digital technology.

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

Cited by 6 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

Evaluating EHR-Integrated Digital Technologies for Medication-Related Outcomes and Health Equity in Hospitalised Adults: A Scoping Review

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