Shona McIntyre, MBChB, Toxicology Registrar; David McD Taylor, MBBS, MD, MPH, DRCOG, FACEM, Director of Emergency and General Medicine Research; Shaun Greene, MBChB, MSc (Medical Toxicology), FACEM, Emergency Medicine Physician and Clinical Toxicologist, Medical Director of Victorian Poisons Information Centre.
Introduction of an N-acetylcysteine weight-based dosing chart reduces prescription errors in the treatment of paracetamol poisoning
Article first published online: 2 DEC 2012
© 2012 The Authors. EMA © 2012 Australasian College for Emergency Medicine and Australasian Society for Emergency Medicine
Emergency Medicine Australasia
Volume 25, Issue 1, pages 28–35, February 2013
How to Cite
McIntyre, S., McD Taylor, D. and Greene, S. (2013), Introduction of an N-acetylcysteine weight-based dosing chart reduces prescription errors in the treatment of paracetamol poisoning. Emergency Medicine Australasia, 25: 28–35. doi: 10.1111/1742-6723.12020
- Issue published online: 4 FEB 2013
- Article first published online: 2 DEC 2012
- Manuscript Accepted: 10 OCT 2012
- paracetamol poisoning;
- prescription error
Under- or overdosing of N-acetylcysteine (NAC), when used to treat paracetamol toxicity, is associated with significant morbidity and mortality. This study evaluated the effect of a weight-based dosing chart (WBDC) introduced to decrease NAC prescription errors.
We undertook a pre- and post-intervention trial in a single ED. The intervention (the NAC WBDC) was introduced in January 2011 and publicised by posters and presentations at medical handovers and education sessions. ED staff were not aware that use of the WBDC was to be evaluated. Data were collected using a retrospective explicit medical record review by a single investigator. The study end-point was the proportion of NAC prescriptions with errors.
The 81 and 42 patients enrolled in the pre- and post-intervention periods, respectively, did not differ in age, sex or weight (P > 0.05). Post-intervention, there were significant reductions in prescription errors of fluid type/volume (50.6% vs 4.8%, P < 0.001), NAC dosage (13.6% vs 0.0%, P = 0.01) and infusion rate (11.1% vs 0.0%, P = 0.03). The proportion of prescriptions with any errors also decreased (56.8% vs 14.3%, P < 0.001). However, there were no improvements in the documentation of patient weight (65.4% vs 64.3%, respectively, P = 0.90) or the proportion of incomplete prescriptions (4.9% vs 11.9%, P = 0.16).
The introduction of a WBDC did not produce a clinically significant reduction in major NAC prescription error rates (as pre-defined in this study); however, there was a clear trend towards a reduction. The WBDC significantly reduced total and minor NAC prescription error rates.