SNAP 12-hour N-acetylcysteine regimen improves length of stay and adverse outcomes in NHS Greater Glasgow &clyde

Introduction/background &aims: Paracetamol poisoning is a frequent presentation to hospital traditionally managed with 300 mg/kg of Nacetylcysteine (NAC) administered over 21 h using three infusions The Scottish and Newcastle Anti-emetic Pre-treatment for Paracetamol Poisoning (SNAP) regimen administers the same dose of acetylcysteine over a 12-h period using two shorter infusions 1 It has a similar efficacy to the traditional NAC regimen but fewer adverse reactions and has recently been included in TOXBASE The SNAP regimen was piloted across NHS Greater Glasgow &Clyde (NHSGGC) in order to determine its feasibility and assess its impact on adverse reactions and length of stay Method/summary of work: Following approval by the local area drug and therapeutics committee, the SNAP regimen was used to treat all patients requiring NAC Data were collected from all patients presenting with paracetamol overdose across NHSGGC before and after the introduction of SNAP Eligible patients were identified using their diagnosis coding on discharge Pre-and post-intervention data were retrospectively collected from an 8 week (May to June 2018) and 12 week period (March to June 2020), respectively, the latter to compensate for fewer overall presentations to hospital during COVID-19 pandemic Data collected included pattern of overdose, need for NAC, adverse reactions and length of stay Patients whose discharge was delayed for reasons not related to paracetamol toxicity were not included in length of stay calculations Results/discussion: See Table 1 Fewer patients presented following the introduction of SNAP (141 vs 159) Median ages were comparable Intentional overdoses were the most common pattern of overdose during both periods Similar numbers of patients required admission for treatment with NAC (30 8% vs 29 1%) However, as in previous studies, SNAP is significantly better tolerated with no patients having adverse reactions requiring slowing or pausing of the infusion compared to the traditional regimen Length of stay was also reduced using SNAP compared to the traditional regimen, 42 versus 25 h Conclusion(s): SNAP has been introduced successfully in NHSGGC During the pilot period, no patients suffered adverse reactions compared to 10% of patients being treated with the traditional regimen Length of stay was significantly reduced, shortening a patient's admission by the equivalent of a day, thereby increasing efficiency