Medication errors associated with the use of ethanol and fomepizole as antidotes for methanol and ethylene glycol poisoning.
Author(s): Lepik KJ, Sobolev BG, Levy AR, Purssell RA, Dewitt CR, Erhardt GD, Baker JL, Kennedy JR, Daws DE
Affiliation(s): Department of Pharmacy, St. Paul's Hospital, Vancouver, British Columbia, Canada. firstname.lastname@example.org
Publication date & source: 2011-06, Clin Toxicol (Phila)., 49(5):391-401.
Publication type: Research Support, Non-U.S. Gov't
INTRODUCTION: Little is known about medication errors which occur with the antidotes ethanol and fomepizole, used for treatment of methanol and ethylene glycol poisoning. Study objectives were to describe and compare the frequency, type, outcome and underlying causes of medication errors associated with ethanol and fomepizole. METHODS: Patients aged >/=13 years were included if they were hospitalized in 1996-2005 for methanol or ethylene glycol poisoning and treated with ethanol or fomepizole. Charts from 10 hospitals were separately reviewed by two abstracters who recorded case details. A consensus panel of clinicians used the abstracted data to identify medication errors and classify error outcome. Fisher's exact test determined significant differences in the proportion of ethanol and fomepizole-treated cases with medication error and univariate logistic regression identified risk factors associated with harmful dosage errors. RESULTS: There were 145 ethanol- and 44 fomepizole-treated cases. There was >/=1 medication error in 113/145 (78%) ethanol- and 20/44 (45%) fomepizole-treated cases (p = 0.0001) with more ethanol-related errors involving excessive dose, inadequate monitoring and inappropriate antidote duration. Harmful errors occurred in 19% of ethanol- and 7% of fomepizole-treated cases (p = 0.06) and were largely due to excessive antidote dose or delayed antidote initiation. Occurrence of harmful dosage error was reduced in cases with Poison Control Centre consultation, odds ratio (95% confidence interval) 0.39 (0.17, 0.91), hemodialysis 0.37 (0.16, 0.88), or fomepizole versus ethanol 0.24 (0.06, 1.04). CONCLUSION: Fomepizole was less prone to medication error than ethanol. Error-related harm was most commonly due to excessive antidote dose or delayed antidote initiation.