Development of a patient information leaflet for use following assessment of all patients with reported or suspected paracetamol overdose.

DM Wood1,2, J Barrett1, WL Chan1,3, JRH Archer1,2, PI Dargan1,2. 1Guy’s and St Thomas’ NHS Foundation Trust and King’s Health Partners, London, UK, 2King's College London, London, UK, 3Tan Tock Seng Hospital, Singapore, Singapore

Background: The management of paracetamol overdose was changed on the 2nd September 2012 with the publication of the MHRA guidance entitled: “Paracetamol overdose: new guidance on treatment with intravenous acetylcysteine”. In this guidance, there was the recommendation that patients not treated with acetylcysteine should be given a leaflet after assessment and prior to discharge from hospital covering issues including the risks of paracetamol poisoning and what to do if symptoms developed after discharge. There are “model” leaflets in the MHRA guidance and also on the UK National Poisons Information Service TOXBASE. We describe here the development and piloting of a leaflet to be provided to all patients where paracetamol overdose is reported or suspected including those treated with acetylcysteine, not for just those patients untreated with acetylcysteine.

Methods: We developed a one-page two-sided leaflet incorporating the suggested content from the MHRA and NPIS. Prior to discharge, patients with paracetamol overdose were approached and asked to read the leaflet. They were then asked four questions regarding the content and design of the leaflet, and two questions to assess their understanding of paracetamol-related toxicity and what symptoms would require urgent medical review after discharge.

Results: 14 patients (7 male, 4 female, 1 not recorded; mean ± SD age 39.6 ± 14.0years) participated in the review of the leaflet. The responses in relation to the design and content of the leaflet are shown in the table.

All 14 participants were aware “the organ most affected by paracetamol overdose” was the liver (alternatives were pancreas, heart and lungs). Specific symptoms requiring medical review: 1. Abdominal pain: True 14; False 0; 2. Yellow discolouration of skin or eyes: True 14; False 0; 3. Headache: True 12; False 2. The individual who disagreed with the statement “I know what symptoms I should watch out for after going home”, correctly responded to all of these three symptoms requiring urgent medical review suggesting that they were in fact aware of what symptoms to be aware of.

Discussion: Following the change in the UK management of paracetamol overdose, we developed a one-page two-sided leaflet to give to all patients where paracetamol ingestion has been reported or suspected prior to discharge from hospital. This pilot study shows that the leaflet was well received and appears to provide patients with appropriate information suggested in the MHRA guidance.