Nursing attitudes towards charcoal administration--impact on patient care

In 1990, the American Association of Poison Control Centers identified that for the first time activated charcoal (AC) use had surpassed that of syrup of ipecac. As nurses are given the primary responsibility for AC administration, it was important to determine how AC was being administered, as well as nursing attitudes towards AC that have an impact on patient care. Surveys were mailed to the Emergency Departments (EDs) of 60 hospitals served by the Pittsburgh Poison Center (PPC); 6 nurses/ED, 2 from each shift, were asked to respond. Forty-four EDs responded (73.3%) providing 237 surveys. Eighty-two percent of nurses stated they disliked administering AC for the following reasons: Patients did not like AC (64.4%); AC soiled clothing (54.7%); and AC took too long to give (35.5%). Prior to administration, 70.9% of the nurses responded that they shook the AC a minimum of 20 times; 9.3% commented that AC still failed to resuspend. Specific administration techniques included attempts to mask the appearance the the AC (67.1%) and attempts to increase AC's palatability by adding a flavoring agent (37.6%) or by using AC with sorbitol instead of aqueous AC (25.7%). Of note was that the flavoring agents used were those known to decrease AC's ability to adsorb toxins. As the majority of problems with AC involved its poor resuspendibility and palatability, an AC fact sheet was developed and mailed to EDs to provide suggestions on AC resuspension and means of enhancing patient acceptance without compromising AC's adsorptive capacity. By surveying nursing attitudes toward AC and the administration techniques being utilized, the PPC was able to identify specific problems and address nursing concerns in a way that positively impacts patient care.