Transcript WHAT IS A POISON CENTER?

WHAT IS A POISON CENTER?
DO YOU REALLY KNOW?
Rita Mrvos RN, BSN, CSPI
Manager of Poison Center Operations
Pittsburgh Poison Center
University of Pittsburgh Medical Center
Pittsburgh, Pa. 15213
US POISON CENTER EVOLUTION


1940-50’s
800-1400 home poisoning
fatalities/yr
 33% < 4 yr of age
1953
First Poison Center

1958
AAPCC

1970
Poison Prevention Packaging Act

1978
~800 Poison Centers




1983
Toxic Exposure Surveillance
System
1988
National Certification
2002
National Toll Free Access
1-800-222-1222
2006
NPDS

2008
61 Centers
24/7 Service
61 US Poison Centers
All 50 States, Puerto Rico & 3 US Territories
What Do Poison Centers Actually
Do?
Poison centers, through their health professional
staff, provide assessment, triage, management
and continued monitoring of more than 2.4 million
poison exposures in the U.S. each year at no
direct cost to the patient.
National Toll-free hotline 1-800-222-1222.
Poison Centers
All US Poison Centers provide 24-hour emergency
and information hotline services via the National
Poison Center Toll-Free Telephone Hotline (1-800222-1222); essential follow-up calls regarding the
continuing care of poison exposures; education;
real-time, nationwide data collection providing
epidemiologic surveillance; and access to
emergency information as an integral part of local,
state, and national emergency preparedness and
response for natural and manmade disasters.
Poison centers or systems must provide service
24 hours per day, every day of the year.
NPDS – NATIONAL POISON DATA
SYSTEM

The American Association of Poison Control Centers (AAPCC)
compiles real-time information reported from the 61 regional
Poison Centers (PCs) into its National Poison Database System
(NPDS).

60 of the nation's 61 US poison centers upload case data
automatically. Most upload every 1- 60 minutes (median 11
minutes) to NPDS creating a real-time national exposure
database and surveillance system.

NPDS has been a collaborative development between AAPCC
and CDC to meet the challenge of forging a true national poison
center system.

NOTE: All data is scrubbed – no patient identifiers are
submitted.
NPDS DATA
These data are used to identify hazards early, focus
prevention education, guide clinical research, direct
training, and detect chemical/bioterrorism incidents.
AAPCC data have prompted product reformulations,
repackaging, recalls, and bans; are used to support
regulatory actions; and contribute to post-marketing
surveillance on newly released drugs and products.
Mistaken Oral Ingestion of Inhalational Medications for Chronic Obstructive
Pulmonary Disease
1Rocky
SM Varney1,2, R Mrvos3, AC Bronstein1,2
Mountain Poison & Drug Center - Denver Health, 2University of Colorado, Denver, CO, 3Pittsburgh Poison Center, University of Pittsburgh
Medical Center, Pittsburgh, PA
Results
Introduction
• Foradil® (formoterol fumarate) and Spiriva® (tiotropium
• A total of 3,919 Foradil and 18,096 Spiriva calls met inclusion
bromide) are medication capsules designed for insertion into
criteria
inhalers for treating chronic obstructive pulmonary disease
• Of these 3,755 (95.8%) Foradil and 17,574 (97.1%) were
• In April 2005 the U.S. Food and Drug Administration (FDA)
mistaken oral ingestions (MOI)
issued a post-marketing alert on mistaken oral ingestion (MOI)
• Both medications showed a 6-fold increase: Foradil 104 to
of Foradil (30 cases) and Spiriva (2 cases)
671; Spiriva 1146 to 7169
• Poison center empiric observation indicated a larger case
• Mean age for Spiriva was 65.5 [min 6, max 95] years, and
count
Foradil 63.3 [min 6, max 96] years
• Our objective was to describe this phenomenon using the
National Poison Data System (NPDS)
Methods
• NPDS was queried for Foradil and Spiriva cases from 1
• The majority of Foradil outcomes were no effect, not
Mistaken Oral Ingestions
Agent
2001
2002
2003
2004
2005
2006
2007
Foradil†
104
403
519
714
648
696
671
Spiriva
*
*
*
1146
3915
5344
7169
followed, unrelated or nonexposures (99.1%) with only 0.9%
minor or moderate outcomes
• Results were similar for Spiriva: 97.8% and 2.2%,
respectively
*Not yet on market
†2000 cases = 0
• Neither drug had a death or major outcome
January 2000 to 31 December 2007
• Search parameters included
• Unintentional misuse or therapeutic error
Conclusions
• Age ≥ 6 years
• Route of administration
• Oral ingestion of capsule-shaped medications formulated for
• Outcome
inhaler use occurs more commonly than in published reports
• Data were compared graphically
1. Open
2. Insert capsule
• NPDS data analysis provides a real-time mechanism to
assess the effect of packaging or formulation changes on
mistaken oral ingestion
Disclaimer
• The views expressed in this document are those of the
author and do not necessarily reflect the official policy or
position of the Air Force, the Department of Defense or the
U.S. Government
3. Pierce Capsule
4. Inhale
POISON CENTER DATA
In 2006, the 61 participating PCs logged
4,033,279 total cases including 2,403,539
human exposure cases
The cumulative AAPCC database now contains
over 43 million human exposure case records
awareness.
PITTSBURGH POISON CENTER
AAPCC CERTIFIED REGIONAL CENTER
DEPARTMENT OF UPMC
24/7 SERVICES
2007 STATISTICS
139,572 CALLS
POPULATION SERVED AND SERVICE AREA
5.9 MILLION
>30,000 SQ MILES
PITTSBURGH POISON CENTER

Staffed by 19 Registered Nurses

18 RN’s are certified by the American Association
as Certified Specialist in Poison Information (1
new staffer not yet eligible to sit for the exam)

Staff average of 17.3 years as a Specialist in
Poison Information

1 Director PharmD Certified Toxicologist

3 MD Board Certified Toxicologists on call 24/7

1 MD Toxicology Fellow
WHO UTILIZES THE
PITTSBURGH POISON CENTER
PUBLIC
OCCUPATIONAL MED MD
PHYSICIANS
POLICE
NURSES
FIRE SERVICES
PHARMACISTS
PRISON OFFICIALS
PARAMEDICS
CORONER’S
VETERINARIANS
ATTORNEYS
URGI-CARE CTRS
INDUSTRY
PITTSBURGH POISON CENTER CALLS
Nurse Practitioner called from xxxx in xxxx. Stated that he
is seeing a pt that works at a car garage and was using
an aluminum cleaner 2 days ago and developed burns to
his hands. He does not have the ingredients.
My son was sitting on the porch with a container of
SPECTRACIDE BUG STOP INDOOR PLUS OUTDOOR
and was sucking on nozzle. He had some on skin also.
"The Tylenol bottle says not to take more than 8 tabs in 24
hrs. I took 8 tabs in 4 days. Is that poisonous?"
Caller questions if green dye on wash cloth is poisonous
thinks he saw some green dye in water when used cloth.
Mom reports that her child drank a small vial of his
inhalation albuterol medication.
PITTSBURGH POISON CENTER
2007
Human Exposures
< 6 years
Animal Exposures
48,998
47.8%
6,625
76.3% Managed on Site/Non HCF
Information Calls
83,949
Patient Care Follow-ups
43,411
PITTSBURGH POISON CENTER

CATS
=
663

DOGS
=
5,897

BIRDS
=
16

AQUATIC =
6

COWS
=
6

HORSES =
3

RODENTS =
28

SHEEP/GOAT=
1

OTHERS =
5
12
M
on
th
s
1
Y
ea
r
2
Y
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r
3 s
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12 rs
C
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19 -1 ar
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ea
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20 Le
-2 ss
9
30 Ye
-3 ars
9
40 Ye
-4 ars
9
50 Ye
-5 ars
9
60 Ye
-6 ars
9
70 Ye
-7 ars
9
90
80 Ye
-9
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or
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M ea
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rs
U
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no ea
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U n
nk A
no du
w lt
n
A
ge
<
%
Percentage by Age Grouping
16
14
12
10
8
6
4
2
0
PITTSBURGH POISON CENTER
CALLS BY DAY OF THE WEEK
8000
7000
6000
5000
4000
3000
2000
1000
0
Sunday
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
PITTSBURGH POISON CENTER
Calls by Month
16K
14K
12K
Call/Month
10K
8K
6K
4K
J
A
N
F
E
B
M
A
R
C
H
A
P
R
I
L
M
AY
J
U
N
E
J
U
LY
2K
0K
025
A
U
G
S
E
P
T
O
C
T
N
O
V
D
E
C
PITTSBURGH POISON CENTER
CALLS BY HOUR
10000
8000
Count
6000
4000
2000
0
0.00 1.00 2.00 3.00 4.00 5.00 6.00 7.00 8.00 9.00 10.00 11.00 12.00 13.00 14.00 15.00 16.00 17.00 18.00 19.00 20.00 21.00 22.00 23.00
Hour
PITTSBURGH POISON CENTER
EDUCATION-2007
 Over 885,000 sheets of Mr Yuk
stickers were distributed.
 Over 347,000 brochures, pencils and
magnets were distributed in
Pennsylvania.
 24 public poison prevention
education lectures and health fairs
were conducted.
CONTACTS
AMERICAN ASSOCIATION OF POISON CONTROL
CENTERS
http://www.aapcc.org
ANNUAL REPORTS!!!!
WWW.MRYUK1.COM
EDUCATION MATERIALS
[email protected]
ME
QUESTIONS