A retrospective review of electronic health records at two urban hospitals shows that some patients may be receiving higher-than-recommended doses of acetaminophen, increasing their risk of toxicity and acute liver failure.

In a study published online in the Archives of Internal Medicine, researchers examined three months of electronic medication administration record data from two Boston-area hospitals, covering more than 14,000 patients. Four percent of those patients received more than the recommended four-grams-per-day dosage of acetaminophen, despite existing policies and procedures put in place to prevent such errors, they found.

The use of eMAR data enabled researchers to make conclusions about patients' actual intake, rather than estimating intake based on whether prescriptions were written and filled, the authors said in the study.

The authors recommended greater reliance on clinical decision-support systems to keep acetaminophen use within set guidelines.

"It is a challenge for clinicians to keep track of the total acetaminophen intake for each patient from the multiple drugs and dosages given over a 24-hour period," they wrote. "Computerized clinical decision-support functionality embedded within clinical information systems could mitigate these risks. For example, liver toxicity warnings for acetaminophen products, recommended by the (U.S. Food and Drug Administration), could be displayed at order entry and during administration."