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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 ultrasound.

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.

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