CLINICAL

PHARMACY

POISON
INFORMATIO
N ORGANISATI
ON
&

RESOURCES
 HISTORY

 In 1930’s – Louis Gdalman established the framework for

the first poison control center at Ruspresbyterian-St.Luke’s
hospital.

 In 1950’s – Missouri pharmacist, Homer George lead a

poison prevention campaign in his hometown that
eventually grew into a National poison prevention week
 In 1980’s – Dr. Joseph Veltri chaired a committee to
improve poison center data collection. This project grew
into the Toxic Exposure Surveillance System(TESS) the
largest poisoning database in the world.

In addition pharmacists provide a key leadership roles in:

 American Association of Poison Control Centers

 American Academy of Clinical Toxicology

 The National Poison Prevention Week Council

 American Board of Applied Toxicology

Poison centers were established for two reasons:
 To provide rapid access to information valuable in assessing
and treating poisonings
 To assist with poison prevention.

GOALS:
 To provide comprehensive, accurate and timely
information to their clients

 To enhance the medical care of patients

Drug Information Center also exist with same goals

as Poison Information center
DIFFERENCES BETWEEN DIC & PIC
Poison Information Drug Information
Center Center

CLIENTELE
 88% poison center calls
 9-10% calls are placed by
are placed by public public,but mostly by
health care professionals.

CALL VOLUME
 103 calls per day, it
 Fewer than 7 calls per
day
ranges from 33 to 213
calls per day. depending
upon service population
size, poison center
awareness in that
area,poisoning rates.
 HOURS OF OPERATION/COST
 Operates 24hrs a day  Operates 9AM-5PM
year round
 More expensive  Less expensive
STAFFING
 They use a wider variety
of health care  They rely on pharmacists
professionals
FUNDING
 Public funding  Sponsored by hospitals or
medical centers
 RESPONSE TIME
 Average response time is  15-30min or it may extend
5min. to days.
CALL COMPLEXITY
 Less complex  More complex
REFERENCES
 Broader based reference  Less than PIC
collection
DOCUMENTATION
 Standardized data  Not present
collection instrument is
present
The data elements that are currently being tracked through the
TESS include:

 General epidemiological data- date and time of call, reason

for exposure

 Caller characteristics- site of caller, city and state

 Patient characteristics- age and sex, pregnancy status

 Exposure characteristics- substance, route of exposure, site

of exposure

 Clinical course- clinical manifestations and therapeutic

interventions
 HOW TO ORGANIZE A POISON CENTER
 Poison center expenses and potential revenues are directly tied to
call volume.
 Therefore one of the most important considerations in organizing
a poison center should be the “ideal human exposure call
volume”.
 Maximal personnel, facility, and reference expenses can be
predicted.
PERSONNEL
1. Medical Director

2. Poison information specialists

3. Manager or Supervisor
1. MEDICAL DIRECTOR: Ultimately responsible
for all medical aspects of the poison center’s operation. The
non physician poison information specialists provide
medical care under the direction and authority of the
program’s medical director.
DUTIES
 Regular review and authorization of all poisoning
management protocols.
 Authorization of poison center policies and procedures
 Participation in staff training
 Provision of on-call clinical support for poison center
staff
 Participation in quality assurance activities
 Liaision with local medical societies, physicians, EMS,
state and federal agencies
 Promotion of research
 Coordination of professional education efforts
 Most poison center medical directors are board certified in
internal medicine, pediatrics, or family practice.
 One indicator of expertise in medical toxicology might be
board of certification through the Medical Toxicology
Subspeciality Examination offered jointly by the American
Board Of Pediatrics, American Board Of Emergency Medicine
and American Board Of Medical Toxicology.
 According to AAPCC criteria for certification as a Regional
Poison Center, the medical director should devote 50% of his or
her professional activities to toxicology and spend atleast 10hrs
per week working on poison center related activities.
 If the medical director is performing the duties outlined
previously, it is likely that his or her time commitment will be
met.
2. POISON INFORMATION SPECIALISTS
 They directly interact with the public and health care
professionals.
 Poison information specialists must be both clinicians and
counselors. They must elicit a complete history, correctly assess
the potential severity of exposure using the most appropriate
management plan to the caller.
 In addition, poison information specialists must be able to focus
callers who are unable to give cohesive history.
 Specialists should be able to communicate in a calm , reassuring
manner at all levels of education.
 Both nurses and pharmacists are suitable poison information
specialists.
 A national certification examination for specialists in poison
information is offered each may through the American
Association Of Poison Control Centers.
 To take the examination , specialists must provide evidence that
they have handled 2000 poison exposure cases and have worked
2000 hrs in poison center.

 In addition, they must have the approval of their center’s

medical directors

 Certification is maintained by continuing to work atleast 8

annualized hours per week in poison center and passing the
certification exam at atleast every 7 years.

 The American Association Of Poison Control Centers mandates

that specialist must work a minimum annualized average of
16hrs per week. This drops to 8 hours a week once they have
been certified.
 Many centers tend to use part-time specialists working an average
of 20 hours per week.

 On-call responsibilities may be integrated into the schedule so

that unexpected coverage is handled fairly and efficiently.

 The on-call person may be paid a minimum hourly base rate. If he

or she is called into the work, the person is paid one and one-half
times the regular rate of pay.
3. MANAGER/SUPERVISOR
 The manager is responsible for administrative aspects of the
center’s operation.
 Ideally this person has established clinical, administrative and
supervisory skills

DUTIES
 Budgeting
 Purchasing
 Staff scheduling, supervision, training
 Maintenance of continuous quality improvement program
 Development of department policies and procedures
 Preparation of administrative reports
 Media response
 Professional education
 The manager/supervisor should know all aspects of the poison
center’s program and have a complete knowledge base in clinical
toxicology.

 The manager should be able to assist specialists during the

assessment of difficult cases and substitute for specialists when
the need arises.

 Many programs use pharmacists with postdoctoral training in

clinical toxicology to fill this position, however, experienced nurses
and physicians work equally as well.

 Certification through the American Board of Applied Toxicology or

in the case of physicians, through the Medical Toxicology Sub-
speciality Examination provides evidence of an ongoing interest
and expertise in clinical toxicology.
 PUBLIC EDUCATION COORDINATOR
 Ideally this coordinator has a background in education and media
communications and experience as poison information specialist

 The duties of public education coordinator may include:

 Development, distribution and evaluation of poison prevention

programs and materials

 Coordination of regularly occuring public education messages

through the media.
 Networking with schools and other organizations to provide cost-
effective public education.

 Coordination of poison prevention through poison information

specialists.
OTHER PERSONNEL
 Secretarial support
 Volunteers
 Toxicology professionals
 Advisory boards

IDEAL LOCATIONS

 Emergency department
 Next to a large medical library
 Hospital pharmacies
 Schools of pharmacy
 DIC
 The work area should be designed to allow 100-200 square feet
per work station and should be situated in a relatively quiet
situation.
 Some poison centers prefer to separate work stations into walled
cubicles to further eliminate peripheral distractions.
 Because stress is the primary draw back to working in a poison
center, the work area should be designed to reduce stress as much
as possible.
 Windows and natural lightning, ergonomic furniture, aquariums
and soothing colors are starting points.
 The poison center medical director’s and manager’s offices
should be adjacent to the main work area rather than in a different
part of the facility,so,these individuals can provide constant
support
 Portable telephones, call-answering devices and call forwarding
to a cellular telephones are less expensive alternatives that
provide varying degrees of functionality.
EQUIPMENT
 Telephone

 Personal computers

 Modem

 Facsimile machine

 Refrigerator and microwave

 File cabinets and shelving

 Generator
RESOURCES
 Micromedex’s poisindex(a database of more than 8,00,000
household products, chemicals, and medications)

 General product formulations are found in Clinical Toxicology

Of Commercial Products by Gosselin, Smith, and Hodge.

 In addition they often maintain manufacture files with recent

product formulations

 Information required stems from a specialized branch of

toxicology

 Internal protocols, journals, medical literatures

POLICIES AND PROCEDURES
 It frames the poison center’s methods of operation.
 It clarifies the direction of the program and relates each operational
facet and each other’s position in the poison center to the main
operational directives
 At a minimum, each policy and procedure should be dated and
signed by the medical director indicating that they have been
reviewed and approved by this individual.
 In some settings there may be additional approvals required
 It is useful to maintain system for tracking policies and procedures
so that when questions arise there is a simple way to determine
operational policies existing at any given moment.
 Database management programs simplify much of this record
keeping and reduce record storage requirements.
TRAINING OF SPECIALISTS
 The goals of training are to establish a comfortable telephone risk
assessment routine, while gradually building the specialist’s
knowledge base in clinical toxicology and fine-tuning telephone
communication skills.

 Most poison centers spend between 6 and 8 weeks training

specialists.

 The format varies depending on the center’s call volume, the

staff’s experience, and allocation of resources by the sponsoring
institution.
Basic training elements should include a discussion of:

 Policies and procedures

 Data collection format

 Reference use

 General poisoning management strategies

 Telephone communication technique

 Assessment and treatment of common deadly poisonings

THE FUTURE OF POISON CONTROL
 The poison information system is rapidly changing. Since its
inception 40yrs ago, pharmacy has provided unique leadership
and expertise.
 As long as medications top the list of substances responsible
for poisoning, pharmacy will always be an integral part of the
poison information system.
REFERENCE
 Drug information-A guide for pharmacists by Patrick
M.Malone.
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