Quality improvement process in the adherence to gastric decontamination guidelines for poison exposures as recommended by a poison control center.
OBJECTIVE
Adherence to new guidelines for the use of ipecac syrup, gastric lavage, cathartics, and activated charcoal by a poison control center was studied with a quality improvement framework.


METHODS
The rates of gastric decontamination were monitored through an electronic case record system. In February 2002, a revised guideline that narrowed the use of gastric decontamination was implemented with a performance improvement process. The rates of recommendation and utilization during 12 months following implementation of the new guidelines were compared with those during 12 previous months.


RESULTS
Recommendations for the use of ipecac syrup declined from 1.50% to 0.02% (OR; 95% CI = 0.02; 0.01, 0.03), single-dose-activated charcoal declined from 5.39% to 1.38% (0.25; 0.22, 0.28), gastric lavage declined from 4.19% to 0.22% (0.05; 0.04, 0.06), and a cathartic declined from 1.48% to 0.13% (0.08; 0.06, 0.12). Declines in utilization were also significant (P < .001) for all forms of gastric decontamination. The proportions of patients managed at the scene of the poisoning were unchanged (1.04; 0.99, 1.09) before (67.64%) and after (68.50%) the new guidelines as were those for referral to a health care facility (20.57% and 21.42%, respectively, 1.05; 1.00, 1.11).


CONCLUSIONS
Recommendations on gastric decontamination can be effectively modified with no detriment to patient outcome.
Chyka
Peter A
PA
Colleges of Pharmacy and Medicine, The University of Tennessee Health Science Center, Memphis, TN 38163, USA. pchyka@utmem.edu
Winbery
Stephen L
SL
D003666:Decontamination / Q000592:standards*; D005751:Gastric Lavage / Q000379:methods* / Q000706:statistics & numerical data; D017408:Guidelines as Topic; D008485:Medical Audit; D011039:Poison Control Centers; D011041:Poisoning / Q000628:therapy*; D011785:Quality Assurance, Health Care / Q000458:organization & administration*