Transcript QIA conference poster – Stephanie Wilson and James

Recording Weights and Paracetamol Use
on Care of the Elderly Wards
Stephanie
a
Wilson ,
James
a
Kearney
and Ray
b
Sheridan
a. Foundation Year 1 Doctors, Royal Devon and Exeter Hospital. b. Health Care for the Elderly Consultant, Royal
Devon and Exeter Hospital. Contact: [email protected].
Problem/Background
- Paracetamol is a potentially hepatotoxic drug and is one of the most commonly prescribed in hospital.
- The dose given needs to be adjusted when given via the intravenous route for patients weighing less than 50kg.
Some evidence suggests it should be adjusted when given orally in underweight patients as well1, 2.
- Patients’ weights are often not written on there drug charts. As a result, it is difficult for doctors to prescribe
weight-dependant drugs, including paracetamol, safely.
Project Design/Strategy
Baseline Measurement
I. Baseline data collection:
-Drug charts were analysed once a week for four weeks
in October 2013 to establish baseline measures
-The charts for all patients on three care of
the elderly wards at the Royal Devon and
Exeter hospital were included (except those
receiving end-of-life-care)
-All analysed charts were marked and
excluded the following weeks
-209 charts were analysed in total
I. Weights:
II. Intervention
i. Presentation of baseline measurements with
discussion at care of the elderly doctors’
educational meeting
ii. Discussion with ward matrons and members of
nursing staff
iii. Posters of baseline measurements with educational
material on all three wards
III. Outcome data collection
-The drug charts were re-analysed once a week for four
weeks in March/April 2014 following the intervention
period
-The charts for all patients on the same three
care of the elderly wards at the Royal Devon
and Exeter hospital were included (except
those receiving end-of-life-care)
-All analysed charts were marked and
excluded the following weeks
-198 charts were analysed in total
15% of patients had their weight recorded on their drug chart
II. Paracetamol prescribing in patients <50kg:
25% of patients (4 of 16) on oral paracetamol had an adjusted dose
Only 2 patients were on iv paracetamol – both on an adjusted dose
200
100
Baseline
Post Intervention
0
Total
Weight Known
Figure 1. Recording of weights
Weight on
Drug Chart
16
12
On Oral
Paracetamol
On Adjusted Dose
8
4
0
Baseline
Post Intervention
Figure 2. Oral paracetamol prescriptions in patients <50kg
Results
I. Weights
30% of patients had their weight recorded on their drug chart
II. Paracetamol prescribing in patients <50kg:
27% of patients (3 of 11) on oral paracetamol had an adjusted dose
Only 2 patients were on iv paracetamol – only one on an adjusted
dose
Lessons Learnt
- Our intervention made a small difference in the recording of weights on the drug chart. No improvement in paracetamol dosing
was achieved.
- The intervention we conducted was not sufficient enough to change practice. Further intervention is required to improve these
outcomes
- Mandatory training for doctors and pharmacists would help to ensure that paracetamol doses are adjusted correctly
- More prominent positioning of the weight box (perhaps alongside the allergies box) would help improve recording on drug
charts.
- Ultimately, electronic prescribing would be the gold standard for ensuring that doses adjusted to weights are always used.
References:
1.
2.
Claridge, Eksteen, Smith, Shah and Holt (2010). Acute liver failure after administration of paracetamol at the maximum recommended daily dose in adults. BMJ, Vol. 341, pp. 1269-70
Pearce and Grant (2008). Acute liver failure following therapeutic paracetamol administration in patients with muscular dystrophies. Anaesthesia, 63, pp. 89-91