Background: Acute pancreatitis (AP) is often a mild self-limiting illness, but in severe cases, it is associated with high mortality rates. Initial management of AP is a cornerstone of treatment to prevent severe disease progression. This audit aimed to assess the initial management of AP to Portiuncula University Hospital (PUH) as recommended by the 2003 Royal College of Surgeons Ireland guidelines, 2018 UK National Institute for Health and Care Excellence (NICE)guidelines, and 2024 American College of Gastroenterology guidelines. It also aimed to assess the utilization of a new screening and management tool for AP in PUH.
Methods: A retrospective chart review was carried out on patients admitted with a confirmed diagnosis of AP at PUH between 1st of July and 30th of November 2025. A total of 32 patients were identified through a review of surgical lists, 22 of whom were included in the analysis after exclusion criteria were applied. Data collected included sex, age, documentation and application of preferred severity scoring tools (Glasgow Imrie), analgesia, intravenous (IV) fluids, proton pump inhibitors (PPIs), anti-emetics, antibiotic usage, monitoring of input and output, as well as nutrition.
Results: There were very high levels of adherence to Guidelines in providing timely supportive treatment, including pain management, anti-emetics, and monitoring of input and output. There was excellent initial resuscitation of patients with AP, including timely administration of IV crystalloid fluids. However, this audit is limited as it did not include the analysis of the rate of fluid resuscitation. PPIs were prescribed to all but one patient. There was good documentation of nutrition and the Malnutrition Universal Screening Tool (MUST) screening. The Glasgow Imrie score was documented in 50% of charts within the first 48 hours. There was a relatively high instance of prescribing antibiotics for mild/moderate AP where no concurrent infection or complications such as infectious necrosis were identified from a review of the chart (27%). The new bespoke screening tool was used in 18% of charts, included in but left incomplete in 32% of charts, and excluded completely in the remaining 50%.
Conclusions: Overall, there remain areas for improvement in the initial management of AP in PUH. In particular, the use of risk stratification scoring could be further optimized along with the bespoke screening and management tool. The role of prophylactic antibiotics in AP should be reviewed. These improvements may be achieved through further education and possibly a review of the bespoke screening tool.
