Objectives: Activated charcoal is now the mainstay of non-specific treatment for self poisoning in accident and emergency (A&E) departments and should be administered within one hour of ingestion of an overdose. This study aimed to investigate if compliance with treatment guidelines may be improved by the prehospital administration of activated charcoal. Method: Ambulance report forms and case notes were reviewed in all patients presenting to A&E by ambulance after self poisoning. Information was gathered using a standardised abstraction form. The times collected were: time of ingestion, time of call to ambulance control, time picked up, time of arrival in A&E and time seen by doctor. Results: 201 patient records were reviewed. Twenty six were excluded because of incomplete data on report forms or case notes. The median time between ingestion and pick up by an ambulance crew was 77 minutes. This compares with a median of 140 minutes for the time to assessment by medical staff. Seventy three patients were picked up by an ambulance within one hour of overdose, only 11 (15%) of these were seen by medical staff within an hour of ingestion. Forty nine of these 73 patients would have been suitable candidates to receive activated charcoal. Conclusions: The prehospital administration of charcoal provides an opportunity to comply with international guidelines on reducing the absorption of a potentially fatal overdose.The administration of charcoal results in few side effects provided the patient can adequately protect their airway and ambulance staff could be trained in its use. Further studies would be necessary to investigate if this would effect clinical outcome.A ctivated charcoal is a preparation commonly used in the first line treatment of overdose in accident and emergency (A&E) departments. Its use can reduce the absorption and aid the elimination of certain drugs by adsorbing the drug in the gastrointestinal tract.1 Recent evidence has lead to more restricted indications for the use of gastric lavage and has rendered the emetic, ipecachuana obsolete.2 3 Both can produce a "wash through" of drug into the duodenum, in theory leading to faster absorption and circulation within minutes.4 Activated charcoal therefore often forms the main, non-specific gut decontamination treatment available in A&E. 2 It is advised that charcoal should be administered within one hour of ingestion of a potentially toxic amount of most poisons.1 This objective is difficult to attain because of the time taken to contact emergency services or to transport the patient to hospital where the charcoal can be prescribed. The aim of this study was to assess the proportion of patients in which prehospital administration was feasible, so improving compliance with current guidelines.
METHODSThe study took place in the Accident and Emergency Unit in Raigmore Hospital, Inverness. This unit sees approximately 26 000 new patients per annum and covers a geographical area the size of Wales. The study started in June 1999 and continued for a period of ni...
Objectives: To evaluate the implementation of a regular Nursing Round as an educational strategy for workplace learning in an intensive care unit with a single room environment. Research Design: A multiple methods design was used. Fifty-four Nursing Rounds were observed, and nurses (n=40) completed bespoke evaluative surveys. Structured observational data and open-ended survey responses were submitted to content analysis and descriptive statistics were used to analyse survey findings. Results: Nursing Rounds involved a diverse range of participants, most frequently nurses. The content most frequently discussed was empirical clinical issues, and nurses decided on nursing care actions to address these issues. The most frequently observed outcome of Nursing Rounds was knowledge translation. Nursing Rounds were perceived to positively influence application of evidence in practice, identification of areas for practice improvement and ability to communicate clinical information. Two categories emerged from analysis of open-ended survey questions; (1) 'Positive learning environment', where nurses described Nursing Rounds as a social learning experience; and (2) 'Impediments to Nursing Rounds', including difficulty attending Nursing Rounds due to competing priorities. Conclusion: Nursing Rounds enabled evidence-based learning that enhanced inter-disciplinary collaboration. Further investigation may be required to understand how to enable nurses to attend more frequently, and generate a more holistic, evidence-based discussion.
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