Aims/Objectives/BackgroundParacetamol overdose is the most common drug overdose in the UK. The standard treatment of Paracetamol toxicity is intravenous N-acetylcysteine (NAC) which is usually given as a 21-hour infusion in UK hospitals. A 12-hour infusion known as the ‘SNAP’ regimen has been implemented in some centres and appears on TOXBASE. The SNAP regimen has been associated with fewer anaphylactoid reactions than the standard 21-hour treatment. The SNAP regimen was initiated in two District General Hospital Emergency Departments within the same NHS Trust as part of a quality improvement project (QIP) to determine whether anaphylactoid reactions and inpatient length of stay could be reduced.Methods/DesignTrust guidelines for Paracetamol overdose were revised advising the 12-hour SNAP regimen for treatment of adults along with a pre-filled prescription chart. A retrospective review of patient notes and electronic discharge letters was performed before and following the new guideline to identify patients who received NAC and whether they suffered any adverse reactions. The length of stay was also recorded.Results/ConclusionsIn three months from August to November 2020, across both sites, 60 adult patients received NAC for Paracetamol overdose. Of these, four patients had anaphylactoid reactions to NAC. Following the introduction of the SNAP regimen, in three months between April and June 2021, 36 adult patients received NAC, and there were no adverse drug reactions.Prior to the introduction of the new guideline and prescription chart adult patients admitted for Paracetamol overdose had an average inpatient stay of 48.3 hours compared to an average stay of 44.5 hours following the introduction of the SNAP regimen.The SNAP NAC regimen was not associated with more adverse drug reactions and has decreased length of stay in adult inpatients with Paracetamol Overdose.
Aims/Objectives/BackgroundIn England, the demand for emergency care is increasing, confounded by challenges with recruitment and retention of multi-professional teams in Emergency Departments (ED). The intense working environment that clinical ED staff face is recognised as a cause of staff dissatisfaction, attrition and premature career ‘burnout.’ A new ‘shop floor’ Clinical Educator (CE) role may improve the retention and wellbeing of multi-professional ED teams. A Health Education England pilot developed and recruited CEs across 54 acute trust EDs in England, from 2017. Aston University and the Royal College of Emergency Medicine were jointly commissioned to undertake a service benefit evaluation.Methods/DesignAn online survey was circulated to CEs, learners and managers across the 54 study sites. Each group answered questions relating to experiences, opinions and reflections. Topics included impact of a CE on patient flow, confidence and competence of staff, as well as sustainability and any impact on staff wellbeing.Results/ConclusionsResults314 individuals accessed the survey and 291 eligible respondents completed it, including: 187 learners, 65 CEs and 39 ED Clinical Directors/Managers.Learners (169/187), CE (63/65) and managers (39/39) saw no change/an improvement in patient flow.100% of CEs felt that a CE in the ED improved competence and confidence of staff (88.2% of learners, 89.7% of managers).7% (61/65) of CEs and 87.2% (34/39) managers agree that CEs have improved wellbeing of staff.8% of managers (26/39) were unsure whether the CE role would be funded beyond the pilot, but 66.7% (26/39) strongly supported continuation of the CE role.ConclusionInterim evidence suggests that CEs positively impact the multi-professional ED workforce.
BackgroundIn England, demand for emergency care is increasing while there is also a staffing shortage. The Royal College of Emergency Medicine (RCEM) suggested that appointment of senior doctors as clinical educators (CEs) would enable support and development of learners in EDs and improve retention and well-being. This study aimed to evaluate the impact of CEs in ED on learners.MethodsCEs were placed in 54 NHS Acute Trust EDs for a pilot beginning July 2018 and ending October 2020. Learners from multiple disciplines working at 54 NHS Acute Trust EDs where CEs were deployed were invited to complete an online survey designed to identify the impact of CEs in July of 2019, as part of an interim service evaluation.ResultsRespondents numbered 493 from 49 of 54 study sites, including 286 (58%) medical (non-consultant) and 72 (14.6%) all other nursing, allied health professionals. 9 out of 10 learners reported having experienced a change to their learning as a result of the deployment of CEs in their department. 49.9% (246/493) reported that CEs had a positive impact on their well-being. 95% (340/358) reported an improved accessibility to undertaking clinical based assessments. 78% (281/358) perceived that access to CEs increased likelihood of passing assessments. Of those responding, 80.9% (399/493) reported they would remain/return to the same ED with a CE, and 92.5% (456/493) responded that they would prefer to go to a Trust with a CE.ConclusionsAccording to survey respondents, deployment of CEs across NHS Trusts has resulted in improvement and increased accessibility of learning and assessment opportunities for learners within ED. The impact of CEs on well-being is uncertain with half reporting improvement and the remaining half unsure. Further evaluation within the project will continue to explore the service benefit and workforce impact of the CEED intervention.
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