A Study on the Medication Errors in the Administration of N-Acetylcysteine for Paracetamol Overdose Patients in Malaysia

Abstract

Introduction N-Acetylcysteine (NAC) has been used to treat paracetamol overdose for four decades. But the administration of NAC regimens is complicated. Therefore, medication errors are an ongoing issue in the acute-care setting and directly impact the safety of patients. Objective To evaluate the rate of NAC-related medication errors during the management of paracetamol overdose at a teaching hospital in Malaysia. Methods This clinical audit study was performed retrospectively between June 2008 and June 2011. Patients who presented to the adult emergency department with paracetamol overdose and had received at least the loading dose of intravenous NAC were eligible. Children below the age of 12 years old were not included. Also, patients displaying chronic excessive paracetamol usage or recurrent paracetamol overdose were excluded. We determined the type and frequency of medication errors during intravenous NAC administration. Results The study population ranged from 13 to 87 years old (mean age: 25.06; median: 23) and was predominantly female. The overall prevalence of intravenous NAC-related medication errors was found to be 84.3%. Moreover, the following frequencies were observed based on error type: 5.9% wrong dose, 37.3% incorrect infusion rate, 8.5% interruption during treatment, and 66.5% unnecessary administration. Conclusion We observe a surprisingly high prevalence of medication errors related to the administration of intravenous NAC. Thus, this emerging issue needs be addressed in order to ensure patient safety as well as to prevent unnecessary hospital admissions and/or burdening treatment costs. (Hong Kong j.emerg.med. 2014;21: 361-367)