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Acute Paracetamol Overdose
Clinical scenario
Patients at risk of renal and liver failure following paracetamol overdose are identified by measuring serum paracetamol concentrations at least 4 hours after ingestion. Those in need of treatment are identified using a nomogram. Best results are seen if treatment is started within 8 hours of ingestion
Audit question
In acute paracetamol ovedose, are patients managed appropriately according to best practice guidelines?
Method
Retrospective audit
Sample: 50 consecutive adults (over 16yrs) presenting to the Emergency Department after an acute overdose of paracetamol (with or without other drugs/ alcohol)
Criteria
Inclusions: Patients coded as paracetamol overdose. At least 10 should have been treated with n-acetylcysteine.
Exclusions: Staggered overdoses: Patients who take multiple overdoses of paracetamol over a period of time (greater than 1 hour)
Audits
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1st August 2008
Results
| Date | Patients | Measured | Results | Standard | Regional avg. |
|---|---|---|---|---|---|
| 01st August 2008 | Adults (over 16 years of age) presenting to the ED after an acute overdose of paracetamol, with or without other drugs. Exclusions - Patients presenting more than 24 hours after the overdose and those who have taken a staggered overdose. | Management of patient according to the criteria | Documented time of overdose | 100 % | 100 % |
| Risk assessment documented | 100 % | 100 % | |||
| Levels should be measured at least 4 hours after the documented time of overdose. | 100 % | 100 % | |||
| N-acetylcysteine commenced (where indicated and presented within 8 hours) within 8 hours of overdose. | 100 % | 100 % | |||
| Patients presenting after 8 hours and within 36hours of ingestion with significant overdose (>12g or high risk) receive n-acetylcysteine immediately | 100 % | - |
Comments
Overall a pleasing set of results. However, standards have deteriorated around the management of late presenting patients, which may be due to small sample size, so would benefit from closer investigation.
Audit Bottom Line
A pleasing set of results overall, however a larger sample size needed to generalise results.