2. 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
3. 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
4. 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
5. DIFFERENCES BETWEEN DIC & PIC
Drug Information
Center
Poison Information
Center
CLIENTELE
88% poison center calls
are placed by public
CALL VOLUME
103 calls per day, it
ranges from 33 to 213
calls per day.depending
upon service population
size,poison center
awareness in that
area,poisoning rates.
9-10% calls are placed by
public,but mostly by
health care professionals.
Fewer than 7 calls per
day
6. HOURS OF OPERATION/COST
Operates 24hrs a day
year round
More expensive
STAFFING
They use a wider variety
of health care
professionals
FUNDING
Public funding
Operates 9AM-5PM
Less expensive
They rely on pharmacists
Sponsored by hospitals or
medical centers
7. RESPONSE TIME
15-30min or it may extend
to days.
Average response time is
5min.
CALL COMPLEXITY
Less complex
REFERENCES
Broader based reference
collection
DOCUMENTATION
Less than PIC
Standardized data
collection instrument is
present
Not present
More complex
8. 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
9. 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
10. 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
11. 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.
12. 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.
13. 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.
14. 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 onehalf times the regular rate of pay.
15. 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
16. 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 Subspeciality Examination provides evidence of an ongoing interest
and expertise in clinical toxicology.
17. 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 costeffective public education.
Coordination of poison prevention through poison information
specialists.
19. 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.
20. EQUIPMENT
Telephone
Personal computers
Modem
Facsimile machine
Refrigerator and microwave
File cabinets and shelving
Generator
21. 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
22. 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.
23. 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.
24. 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
25. 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.
Animated floating petals(Difficult)Tip: For best results with the animation effects on this slide, choose a picture with an object that is made up of multiple parts, like the flower in this example. To reproduce the background effects on this slide, do the following:On the Home tab, in the Slides group, click Layout, and then click Blank. Right-click the slide and then click FormatBackground.In the Format Background dialog box, click Fill in the left pane. In the Fill pane, select Picture or texture fill, and then under Insert from, click File. In the Insert Picture dialog box, select a picture, and then click Insert.On the Insert tab, in the Illustrations group, click Shapes, and then under Rectangles, click Rectangle (first option from the left). On the slide, drag to draw a rectangle. Select the rectangle. Under Drawing Tools, on the Format tab, in the Size group, do the following:In the Shape Height box, enter 7.5”.In the Shape Width box, enter 10”.On the Home tab, in the Drawing group, click the arrow next to Shape Outline, and then click No Outline.On the Home tab, in the Drawing group, click the arrow next to Shape Fill, point to Gradient, and then click More Gradients. In the Format Shape dialog box, click Fill in the left pane. In the Fill pane, select Gradient fill, and then do the following:In the Type list, select Radial.Click the button next to Direction, and then click From Center (third option from the left).Under Gradient stops, click Add gradient stops or Remove gradient stops until two stops appear in the drop-down list.Also under Gradient stops, customize the gradient stops that you added as follows:Select the first stop in the slider, and then do the following:In the Position box, enter 0%.Click the button next to Color, and then under Theme Colors click Black, Text 1, Lighter 5% (sixth row, second option from the left).In the Transparency box, enter 40%.Select the last stop in the slider, and then do the following: In the Position box, enter 100%.Click the button next to Color, and then under Theme Colors click Black, Text 1, Lighter 5%(sixth row, second option from the left).In the Transparency box, enter 10%.Select the rectangle. On the Home tab, in the Drawing group, click Arrange, point to Align, and then do the following:Click Align Middle.Click Align Center. To reproduce the shape effects on this slide, do the following:On the Insert tab, in the Illustrations group, click Shapes, and then under Lines, click Freeform (11th option from the left).On the slide, click points to trace an outline around a shape on the background picture (in the example above, one of the flower petals). Right-click the freeform shape and click Edit Points. To make the freeform shape more similar to the shape on the picture, right-click a place to include another point, and click AddPoints. Drag the new point to follow the contour of the shape on the picture. To outline rounded edges of the shape on the picture, right-click a straight line segment, and click Curved Segment.Select the freeform shape. On the Home tab, in the bottom right corner of the Drawing group, click the Format Shape dialog box launcher. In the Format Shape dialog box, click Line Color in the left pane, and then in the Line Color pane, select No line. Also in the Format Shape dialog box, click Fill in the left pane, and then in the Fill pane, select Slide background fill. Repeat the process in steps 1-5to create six full-color shapes on the slide (in the example above, six flower petals from the same flower). To reproduce the animation effects on this slide, do the following:On the slide, select the rectangle. On the Animations tab, in the Advanced Animation group, click Add Animation, and then under Entrance click Fade.Also on theAnimations tab, in the Timing group, do the following:In theStartlist, select After Previous.In the Duration box, enter 2.00 seconds.On the slide, select one of the freeform shapes. On the Animations tab, in the Advanced Animation group, click Add Animation, and then under Emphasis click Spin.Also on the Animations tab, in the Timing group, do the following:In the Start list, select With Previous. In the Duration box, enter 2.00 seconds. On the Animations tab, in the Advanced Animation group, click Add Animation, and then under Emphasis click Grow/Shrink.Also on the Animations tab, in the Timing group, do the following:In the Start list, select With Previous. In the Duration box, enter 2.00 seconds. On the Animations tab, in the AdvancedAnimation group, click AddAnimation, and then click More Motion Paths. In the Add Motion Path dialog box, under Lines & Curves, click S Curve 1.Also on the Animations tab, in the Timing group, do the following:In the Start list, select With Previous. In the Duration box, enter 2.00 seconds. On the slide, select the S curve motion path. Point to the endpoint (red arrow) of the selected right motion path until the cursor becomes a two-headed arrow. Drag the endpoint off the right side of the slide.Right-click the motion path and select EditPoints, and then do the following:Right-click the middle point in the motion path animation and select SmoothPoint.Click the middle point. Drag one of the blue sizing lines until the curve in the motion path is smooth.On the slide, select the animated freeform shape. On the Animations tab, in the AdvancedAnimation group, click AnimationPainter, and then click one of the other freeform shapes. Repeat this process for each of the remaining freeform shapes.Also on the Animations tab, in the Advanced Animation group, click AnimationPane. In the Animation Pane, do the following to edit the animation effects:Select the second animation (first freeform shape spin effect). On the Animations tab, in the Animation group, click the EffectOptions dialog box launcher. In the Spin dialog box, do the following:On the Effect tab, in the Amount list, in the Custom box, enter 360⁰, and then press ENTER. Also in the Amount list, click Counterclockwise. On the Timing tab, in the Start list, select After Previous.Select the third animation (first freeform shape grow/shrink effect). On the Animations tab, in the Animation group, click the EffectOptions dialog box launcher. In the Grow/Shrink dialog box, do the following:On the Effect tab, in the Size list, in the Custom box, enter 40%, and then press ENTER. Also in the Size list, click Vertical. Select the fifth animation (second freeform shape spin effect). On the Animations tab, in the Animation group, click the EffectOptions dialog box launcher. In the Spin dialog box, do the following:On the Effect tab, in the Amount list, in the Custom box, enter 30⁰, and then press ENTER. Also in the Amount list, click Clockwise. On the Timing tab, in the Delay box, enter 0.1.Select the sixth animation (first freeform shape grow/shrink effect). On the Animations tab, in the Animation group, click the EffectOptions dialog box launcher. In the Grow/Shrink dialog box, do the following:On the Effect tab, in the Size list, in the Custom box, enter 40%, and then press ENTER. Also in the Size list, click Vertical. On the Timing tab, in the Delay box, enter 0.1.Select the seventh animation (first S-curve motion path effect). On the Animations tab, in the Timing group, in the Delay box, enter 0.1.Select the eighth animation (third freeform shape spin effect). On the Animations tab, in the Animation group, click the EffectOptions dialog box launcher. In the Spin dialog box, do the following:On the Effect tab, in the Amount list, in the Custom box, enter 40⁰, and then press ENTER. Also in the Amount list, click Clockwise. On the Timing tab, in the Delay box, enter 0.3.Select the ninth animation (third freeform shape grow/shrink effect). On the Animations tab, in the Animation group, click the EffectOptions dialog box launcher. In the Grow/Shrink dialog box, do the following:On the Effect tab, in the Size list, in the Custom box, enter 50%,and then press ENTER. Also in the Size list, click Horizontal. On the Timing tab, in the Delay box, enter 0.3.Select the 10th animation (first S-curve motion path effect). On the Animations tab, in the Timing group, in the Delay box, enter 0.3.Select the 11th animation (fourth freeform shape spin effect). On the Animations tab, in the Animation group, click the EffectOptions dialog box launcher. In the Spin dialog box, do the following:On the Effect tab, in the Amount list, in the Custom box, enter 90⁰, and then press ENTER. Also in the Amount list, click Counterclockwise. On the Timing tab, in the Delay box, enter 0.4.Select the 12th animation (fourth freeform shape grow/shrink effect). On the Animations tab, in the Animation group, click the EffectOptions dialog box launcher. In the Grow/Shrink dialog box, do the following:On the Effect tab, in the Size list, in the Custom box, enter 40%,and then press ENTER. Also in the Size list, click Vertical. On the Timing tab, in the Delay box, enter 0.4.Select the 13th animation (first S-curve motion path effect). On the Animations tab, in the Timing group, in the Delay box, enter 0.4.Select the 14th animation (fifth freeform shape spin effect). On the Animations tab, in the Animation group, click the EffectOptions dialog box launcher. In the Spin dialog box, do the following:On the Effect tab, in the Amount list, in the Custom box, enter 90⁰, and then press ENTER. Also in the Amount list, click Clockwise. On the Timing tab, in the Delay box, enter 0.5.Select the 15th animation (fifth freeform shape grow/shrink effect). On the Animations tab, in the Animation group, click the EffectOptions dialog box launcher. In the Grow/Shrink dialog box, do the following:On the Effect tab, in the Size list, in the Custom box, enter 50%,and then press ENTER. Also in the Size list, click Horizontal.On the Timing tab, in the Delay box, enter 0.5.Select the 16th animation (first S-curve motion path effect). On the Animations tab, in the Timing group, in the Delay box, enter 0.5.Select the 17th animation (sixth freeform shape spin effect). On the Animations tab, in the Animation group, click the EffectOptions dialog box launcher. In the Spin dialog box, do the following:On the Effect tab, in the Amount list, in the Custom box, enter 360⁰, and then press ENTER. Also in the Amount list, click Clockwise. On the Timing tab, in the Delay box, enter 0.6.Select the 18th animation (sixth freeform shape grow/shrink effect). On the Animations tab, in the Animation group, click the EffectOptions dialog box launcher. In the Grow/Shrink dialog box, do the following:On the Effect tab, in the Size list, in the Custom box, enter 50%,and then press ENTER. Also in the Size list, click Horizontal.On the Timing tab, in the Delay box, enter 0.6.Select the 19th animation (first S-curve motion path effect). On the Animations tab, in the Timing group, in the Delay box, enter 0.6.