An integrated care pathway improves the management of paracetamol poisoning.

Abstract

BACKGROUND:

Paracetamol poisoning remains a major cause of morbidity and mortality. Clinical care of paracetamol poisoning depends on a range of patient variables and typically involves both medical and nursing care. An integrated care pathway (ICP) is a multidisciplinary management plan that incorporates guidelines and best practice to enhance care and documentation for a specific patient group. Paracetamol overdose is thus amenable to an ICP.

AIM:

To evaluate the introduction of an ICP on process of care of the paracetamol poisoned patient.

METHODS:

A retrospective case note review of consecutive patients admitted to the Royal Infirmary of Edinburgh following a paracetamol overdose was conducted. Data were collected for a 3-month period before and after introduction of the ICP to the emergency department and toxicology inpatient unit.

RESULTS:

The ICP was used in 77% of cases in the time period studied and was associated with improvements in initial documentation of patient assessment (pre-ICP vs post-ICP: 87/161 (54%) vs 101/113 (89%), p<0.0001) and appropriateness of blood sampling (146/161 (91%) vs 111/113 (98%), p=0.01), but no change in timely blood sampling (pre 124/161 (77%) vs post 93/113 (82%)). All aspects of intravenous acetylcysteine administration also significantly improved: administration of acetylcysteine if indicated (pre-ICP vs post-ICP: 57/71 (80%) vs 71/71 (100%), p<0.0001); acetylcysteine commenced in a timely fashion (33/71 (46%) vs 55/71 (77%), p=0.0002); and acetylcysteine correctly prescribed (44/58 (76%) vs 71/71 (100%), p<0.0001).

CONCLUSIONS:

Implementation of an ICP for paracetamol poisoning significantly improved patient management and helped to standardise inter-professional decision making in this challenging patient group. This is likely to improve patient outcome.

• Authors: Janice M Pettie, Margaret A Dow, Euan A Sandilands, H K Ruben Thanacoody, D Nicholas Bateman
• Journal: Emergency medicine journal : EMJ (Emerg Med J) Vol. 29 Issue 6 Pg. 482-6 (Jun 2012) ISSN: 1472-0213 [Electronic] England
• PMID: 21561983 (Publication Type: Journal Article)

Chemical References

• Analgesics, Non-Narcotic
• Acetaminophen

Topics

• Acetaminophen (poisoning)
• Adolescent
• Adult
• Aged
• Aged, 80 and over
• Analgesics, Non-Narcotic (poisoning)
• Critical Care (methods)
• Critical Pathways (organization & administration)
• Decision Making
• Delivery of Health Care, Integrated (organization & administration)
• Female
• Humans
• Interprofessional Relations
• Male
• Middle Aged
• Pilot Projects
• Program Evaluation
• Retrospective Studies
• Young Adult