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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 December 2012
Results
| Date | Patients | Measured | Results | Standard | Regional avg. |
|---|---|---|---|---|---|
| 01st December 2012 | Adults (over 16 years of age)presenting to the ED after an acute overdose of paracetamol, with or without other drugs. | Management according to criteria | Documented time of overdose | 100 % | - |
| Risk assessment documented | 100 % | - | |||
| Levels should be measured at least 4 hours after the documented time of overdose. | 100 % | - | |||
| N-acetylcysteine commenced (where indicated and presented within 8 hours) within 8 hours of overdose. | 100 % | - | |||
| Patients presenting after 8 hours and within 36hours of ingestion with significant overdose (>12g or high risk) receive n-acetylcysteine immediately | 100 % | - |
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