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Ordering and Administration -

Acetylcysteine intravenous infusion for paracetamol poisoning (also known as NAC or N-Acetylcysteine) FirstNet & Medications Management

Quick reference guide Note: Treatment of paracetamol poisoning requires sequential infusions of N-Acetylcysteine per the state-wide protocol over 20 hours. The IV Sequence function in ieMR is used. This allows multiple infusions to be ordered at the same time and the sequence of administration of each infusion to be specified. Nurses will only be able to begin the second infusion once the first infusion is completed. Steps for Ordering an IV Sequence

1. Navigate to the Orders page and select Add+ to open the Search screen

2. Above the Search field, in the Enter name to create sequence: field, enter a title for the sequence to be ordered (e.g. Acetylcysteine Infusion protocol)

This will populate a blank sequence section at the bottom of the order window

3. In the Search field, type ‘acetylcysteine IV’ and press the Enter key to view all orders

4. Select the appropriate IV set for the first infusion (Infusion 1, 4 hr bag) in the sequence according to the patient’s weight

5. Continue selecting the next order as required for the sequence (Infusion 2, 16 hr bag)

Note: The sequence will be created (from top to bottom) in the order the infusions/fluids are selected. If necessary, the sequence can be rearranged by clicking on the dotted black arrows

beside each order

6. Select Done

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7. The Dosage Calculator will fire for each infusion phase ordered. The patient’s weight will populate if it is current (i.e. documented in the last 7 days)

8. Review the calculated Final dose field and click Apply Dose. The infusions will be listed under the designated sequence heading

9. Select each order to review the Continuous

Details tab

10. Select Sign and enter password 11. Review the MAR (Note: orders are linked

under the sequence heading in Continuous Infusions section)

Steps for Administration of IV Sequence

1. Review MAR. Prepare 1st infusion of acetylcysteine

2. Navigate to bedside, perform PPID, check allergies and Mark all as reviewed

3. In the MAW (Medication Administration Wizard), only the 1st infusion is available. Select the order and click in the Result field to open the Begin Bag window

4. Review order and enter mandatory details

5. Enter nurse witness password and select

OK 6. Select Sign 7. Review MAR

Note: The 2 infusion phases are visible with the End Bag task in 4 hours for the First infusion. Pending task for second infusion is greyed out and cannot be commenced.

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8. Navigate to Interactive View and select Fluid Balance navigator band Note: the 2 infusion phases are visible however only Infusion 1 is available to document hourly totals

9. At the completion of Infusion 1, complete End Bag task Note: On the MAR, Infusion phase 1 has been “greyed” out and Infusion phase 2 is available to be commenced.

10. Commence the second bag (Infusion 2) via the MAW as per Steps 1 – 6.

11. Review the MAR 12. Review Fluid Balance navigator band in

Interactive View Note: Infusion phase 1 is complete and Infusion phase 2 is available to document hourly totals

Refer to following resources for further management: QHEPs Policies & Procedures: • N-Acetylcysteine (Intravenous) for

Paracetamol Poisoning Paediatric Medication Guideline CHQ-PMG-01230

• Paracetamol ingestion – Emergency management in children CHQ-GDL-60018

Note: Please call ieMR on ext. 1999 if you have any questions or concerns.