title: Dissemination and uptake of a new treatment pathway for paracetamol poisoning in the UK: a survey of healthcare professionals.
abstract: OBJECTIVE
  On 3 September 2012, the UK Medicines and Healthcare Products Regulatory Agency (MHRA) notified healthcare professionals of immediate changes to the intravenous acetylcysteine license terms, altering the treatment pathway for paracetamol poisoning. We sought to evaluate awareness of this amongst healthcare professionals.
  
  
  METHODS
  We surveyed doctors, nurses and pharmacists in the 1-12 week period following the implementation date.
  
  
  RESULTS
  Forty-four individuals completed the survey in paper form (response rate 86%) and 220 in electronic form (response rate unknown). The resulting sample of 264 individuals was drawn from 41 institutions, and included 143 doctors, 58 pharmacists and 50 nurses. Of these individuals, 157 (59%) were aware of the changes, and 133 (50%) had adopted them in practice. Awareness differed between healthcare professions (P = 0.001) and specialties (P = 0.002). For respondents aware of the changes, the main sources of information were alerts issued internally (reported by 57%), from the MHRA (25%) and from other professional bodies (24%). The proportion of individuals who reported receiving practical implementation instructions (e.g. a protocol) was higher among respondents who had changed their practice than for those who had not (86 vs. 25%, respectively; P < 0.001).
  
  
  CONCLUSIONS
  Less than two-thirds of healthcare professionals in specialties managing patients with paracetamol poisoning were aware of important changes to its treatment pathway in the 12 weeks after they took effect, and only half had adopted them in practice. Alternative communication strategies should be explored to improve dissemination of similar information from the MHRA and other medicines regulators in the future.
authors.affiliation: Clinical Toxicology, Guy's and St Thomas' NHS Foundation Trust and King's Health Partners, London, UK; Clinical Pharmacology, St George's, University of London, London, UK.
authors.forename: Andrew W
authors.initials: AW
authors.lastname: Hitchings
authors.forename: David M
authors.initials: DM
authors.lastname: Wood
authors.forename: Paul I
authors.initials: PI
authors.lastname: Dargan
mesh_terms: D000082:Acetaminophen / Q000097:blood / Q000506:poisoning*; D000111:Acetylcysteine / Q000008:administration & dosage / Q000627:therapeutic use; D056486:Chemical and Drug Induced Liver Injury / Q000209:etiology / Q000628:therapy; D003695:Delivery of Health Care / Q000331:legislation & jurisprudence* / Q000592:standards*; D033161:Government Regulation; D019538:Health Care Surveys; D007722:Health Knowledge, Attitudes, Practice; D006282:Health Personnel; D006284:Health Plan Implementation; D006801:Humans; D033181:Information Dissemination / Q000379:methods*; D007275:Injections, Intravenous; D010865:Pilot Projects; D017410:Practice Guidelines as Topic / Q000592:standards*; D011795:Surveys and Questionnaires; D006113:United Kingdom
chemical_list: D000082:Acetaminophen; D000111:Acetylcysteine
keywords: acetaminophen; acetylcysteine; information dissemination; professional practice