title: Awareness, acceptability and application of paracetamol overdose management guidelines in a New Zealand emergency department.
abstract: OBJECTIVE
  To measure emergency physicians' awareness, acceptance, access to and application of the Australasian Paracetamol Overdose Guidelines.
  
  
  METHODS
  A retrospective record review of 100 consecutive presentations with the complaint of paracetamol overdose to the Dunedin Hospital Emergency Department, New Zealand, from 1 December 2011 to 31 December 2012, with: comparison of management to that recommended by the Guidelines, analysis of access to both an Internet poisons information resource and the New Zealand National Poisons Centre, survey of clinical staff opinion of the Guidelines and, comparison of actual and recommended management costs at commercial laboratory rates and with application of the WHO-CHOICE unit cost estimates for service delivery.
  
  
  RESULTS
  Response rate to the survey was 92.9% with 96.2% of responders aware of or accessing the Guidelines when managing paracetamol overdose patients (0.28% of Emergency Department encounters). Record review identified adherence to the Guidelines in 19% of patients; the greatest deviation due to increased biochemical analysis (68% of patients) at a mean cost $59.32 per patient greater than recommended - junior doctors ordering twice the cost in investigations as their seniors. Mean cost of care was calculated at $686.89 per case.
  
  
  CONCLUSIONS
  The application of poisons information guidelines by front-line medical staff is limited; innovative approaches to improve adherence to clinical management recommendations need to be considered.
authors.affiliation: Preventive and Social Medicine, University of Otago, PO Box 913, Dunedin, New Zealand. john.fountain@otago.ac.nz.
authors.forename: John S
authors.initials: JS
authors.lastname: Fountain
authors.forename: Hamed
authors.initials: H
authors.lastname: Hawwari
authors.forename: Kate
authors.initials: K
authors.lastname: Kerr
authors.forename: Alec
authors.initials: A
authors.lastname: Holt
authors.forename: David
authors.initials: D
authors.lastname: Reith
mesh_terms: D000082:Acetaminophen / Q000506:poisoning*; D000293:Adolescent; D000328:Adult; D000368:Aged; D018712:Analgesics, Non-Narcotic / Q000506:poisoning*; D001291:Attitude of Health Personnel; D002648:Child; D002675:Child, Preschool; D002983:Clinical Competence / Q000706:statistics & numerical data*; D062787:Drug Overdose / Q000175:diagnosis / Q000191:economics / Q000628:therapy*; D004636:Emergency Service, Hospital / Q000191:economics; D005260:Female; D019983:Guideline Adherence / Q000706:statistics & numerical data*; D019538:Health Care Surveys; D017721:Hospital Costs / Q000706:statistics & numerical data; D006801:Humans; D007223:Infant; D008297:Male; D008875:Middle Aged; D009520:New Zealand; D017410:Practice Guidelines as Topic; D012189:Retrospective Studies; D055815:Young Adult
chemical_list: D018712:Analgesics, Non-Narcotic; D000082:Acetaminophen