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Paracetamol prescribed and offered despite documented allergy (12HDC00785)
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(12HDC00785, 28 March 2014)
Emergency department ~ ED consultant ~ District health board
~ Public hospital ~ Abdominal pain ~ Medication allergy ~
Prescribing error ~ Paracetamol ~ Right 4(1)
A woman presented at an emergency department (ED), on referral
from her general practitioner (GP), with a two-day history of
abdominal pain and nausea. The woman was prescribed pain relief
medication, and was advised to return the next day for a renal
The renal ultrasound showed no obvious renal pathology. The
woman was discharged home with pain relief medication, and advised
to seek a further review if her pain did not settle. A week later,
due to ongoing pain, the woman's GP referred her to the ED for an
abdominal computerised tomography (CT) scan. The scan showed no
obvious pathology, and the woman was again discharged home with
pain relief medication.
The woman then consulted a private surgeon, who referred her to
the public hospital for an urgent CT IVU (intravenous urogram)
scan. The woman presented to for the scan, at which time the
hospital radiologist elected to perform a CT KUB (CT of the
kidneys, ureter and bladder) scan instead. The scan showed "two
tiny calculi in the left renal substance", but no significant
abnormality outside the urinary tract.
Subsequently the woman presented at ED with continuing pain. On
this occasion, she was prescribed paracetamol despite having a
documented allergy to the drug. A nurse attempted to administer the
drug to the woman before her allergy was ascertained.
It was held that the woman received care of a reasonable
standard at her initial presentation with abdominal pain and
nausea, and that the radiologist's change in CT scan ordered by the
private surgeon was also reasonable.
However, the district health board breached Right 4(1) of the
Code of Health and Disability Services Consumers' Rights for
prescribing paracetamol to the woman during her subsequent
presentation, despite her having a documented allergy.
Adverse comment was made about the ED
consultant who did not ascertain the woman's allergy status
adequately prior to prescribing paracetamol.