Better IT needed to monitor medication doses, researchers say

Study of patient EHRs uncovers hospital patients often given too much acetaminophen
Tools

Hospital patients--even those with liver disease--often are given too much acetaminophen, which commonly is sold as Tylenol, but also is an ingredient in stronger narcotics such as Percocet and Vicodin, according to a study published in the Archives of Internal Medicine.

The researchers, from Partners HealthCare System in Wellesley, Mass., say better health IT systems are needed to monitor aggregate doses of ingredients such as acetaminophen when patients are given multiple medications, a Reuters story reports.

Citing its link to liver damage, the U.S. Food and Drug Administration has set the maximum daily dose at 4 grams for most people or 3 grams for people 65 and older and those with liver disease. The study of the electronic medical records of 14,411 patients at two medical centers found that 6.6 percent were given more than 4g per day. In addition, 22.3 percent of patients 65 years or older and 17.6 percent of patients with chronic liver diseases were given more than the recommended limit of 3g per day.

They found that scheduled dosing, instead of administering it as needed, an osteoarthritis diagnosis, and use of multiple formulations were linked to the higher doses, according to MedPage Today.

"It is a challenge for clinicians to keep track of the total acetaminophen intake for each patient from the multiple drugs and doses given over a 24-hour period," the authors wrote. "Computerized clinical decision support functionality embedded within clinical information systems could mitigate these risks."

Robert Fontana, a liver specialist from the University of Michigan Health System in Ann Arbor, who was not involved in the research, told Reuters that with the FDA cracking down on high doses of acetaminophen in narcotics, he foresees the problem occurring less often in the future.

An FDA panel in 2009 recommended pulling Vicodin, Percocet and seven other acetaminophen/narcotic combos from the market due to concerns about the acetaminophen. The agency and the Drug Enforcement Administration are still wrangling over how tightly the two should be regulated to prevent abuse, however, according to a second MedPage Today article from last month.

To learn more:
- read the abstract
- here's the Reuters story
- check out the MedPage Today article
- read the second MedPage Today piece

Related Articles:
Monthly use of acetaminophen can double risk of asthma
FDA committee wants to pull Vicodin, Percocet off market
6 ways to improve safety of medication administration and delivery