Hayes Bryan D, Klein-Schwartz Wendy, Doyon Suzanne
Maryland Poison Center, School of Pharmacy, University of Maryland, Baltimore, MD, USA.
Ann Pharmacother. 2008 Jun;42(6):766-70. doi: 10.1345/aph.1K685. Epub 2008 Apr 29.
Acetadote, an intravenous preparation of acetylcysteine, became commercially available in the US in June 2004 for the treatment of acetaminophen poisoning. The dosing regimen is complex, consisting of a loading dose followed by 2 maintenance doses, each with different infusion rates.
To analyze the frequency of medication errors related to the complex dosing regimen for intravenous acetylcysteine.
A retrospective chart review of a regional poison center's records was performed for all patients treated with intravenous acetylcysteine from August 1, 2006, to August 31, 2007. Data collected included acetylcysteine dose, infusion rate, interruptions in therapy, unnecessary administration, and medical outcome. Records that revealed medication errors were further examined for the time and location of the errors.
There were 221 acetaminophen overdose cases treated with intravenous acetylcysteine that met inclusion criteria. Of these, 84 medication errors occurred in 74 (33%) patients. The frequency and types of errors were 1.4% incorrect dose, 5% incorrect infusion rate, 18.6% more than 1 hour of interruption in therapy, and 13.1% unnecessary administration. The frequency and types of medication errors in pediatric patients were similar to those in the total patient population. Errors occurred most frequently in the emergency department compared with intensive care units or general medical floors. In addition, errors occurred most frequently on third shift, compared with first or second shift. Evaluation of medical outcomes in cases involving acetaminophen only found that medication errors did not have an impact on coded outcomes.
Medication administration errors occur frequently with intravenous acetylcysteine. Awareness of this problem, coupled with increased vigilance in identifying factors associated with errors, should decrease medication errors with intravenous acetylcysteine therapy for acetaminophen poisoning.
乙酰半胱氨酸静脉制剂Acetadote于2004年6月在美国上市，用于治疗对乙酰氨基酚中毒。给药方案复杂，包括一个负荷剂量，随后是两个维持剂量，每个剂量的输注速率不同。
分析与静脉注射乙酰半胱氨酸复杂给药方案相关的用药错误发生率。
对2006年8月1日至2007年8月31日期间在某地区毒物中心接受静脉注射乙酰半胱氨酸治疗的所有患者的病历进行回顾性分析。收集的数据包括乙酰半胱氨酸剂量、输注速率、治疗中断情况、不必要的给药以及医疗结局。对发现用药错误的病历进一步检查错误发生的时间和地点。
有221例对乙酰氨基酚过量病例接受了静脉注射乙酰半胱氨酸治疗并符合纳入标准。其中，74例（占33%）患者发生了84次用药错误。错误的发生率和类型分别为：1.4%剂量错误、5%输注速率错误、18.6%治疗中断超过1小时、13.1%不必要的给药。儿科患者用药错误的发生率和类型与总体患者群体相似。与重症监护病房或普通内科病房相比，急诊室发生错误的频率最高。此外，与第一班或第二班相比，第三班发生错误的频率最高。仅涉及对乙酰氨基酚病例的医疗结局评估发现，用药错误对编码结局没有影响。
静脉注射乙酰半胱氨酸时用药错误频繁发生。认识到这个问题，并在识别与错误相关的因素时提高警惕，应该会减少对乙酰氨基酚中毒静脉注射乙酰半胱氨酸治疗时的用药错误。
