Poison Control
Loren Bonner
With National Poison Prevention Week coming up March 15–21, 2020, pharmacists have a chance to properly display and hand out those familiar 800-222-1222 poison control help line stickers. But there are more ways—besides the sticker—for pharmacists to engage with poison control.
“We are free expert advice,” said Serena Huntington, PharmD, DABAT, managing director of the California Poison Control System–Madera division at Valley Children’s Hospital. “We even have over 100 language translators available.”
Experts, including many clinical toxicology-trained pharmacists, answer poison control calls 24 hours a day, 7 days a week, every day of the year. They are a resource for poison information, clinical toxicology consultation, and poison prevention education.
Leading cause of death
Surpassing motor vehicle fatalities, poisoning is the leading cause of injury death in the United States. In 2017, when national statistics were last available from the annual report of the American Association of Poison Control Centers’ (AAPCC) National Poison Data System (NDPS), just over one-half (53%) of human exposure cases managed by poison control centers involved drugs and medications.
Poisoning by analgesics for all age groups—both intentional and nonintentional—led all cases of poisoning reported to U.S. poison control centers, according to the same 2017 data.
Poison control has seen it all
It’s not uncommon for Huntington to get calls from community pharmacists, hospital pharmacists, and other medical providers.
“It’s never something they have seen, but we usually have,” said Huntington.
For instance, a community pharmacist may call poison control if their patient took a double dose of medication. Or a patient may be concerned about certain symptoms from their medication and wants to know how to proceed.
“We can triage the patient on the phone and see if they need the emergency room or a visit to their doctor’s office or if they would be okay at home,” said Huntington.
Allison Muller, PharmD, DABAT, a toxicologist and consultant, said she has often encountered community pharmacists calling poison control about a medication misfill reported by the patient.
“Pharmacists should contact the patient’s provider in the case of a misfill and refer the patient for immediate medical attention if needed. These actions can be in concert with a call to the poison control center to get insight into the risks associated, if any, with the medication error,” said Muller.
Huntington said if a community pharmacist is stuck on a drug information question, poison control can help.
“We get all the FDA warnings and recall notices and can be a resource for that,” she said. If pharmacists want to know about any drug trends in their individual state, poison control can provide that information.
Frequent callers
Most often, poison control centers get calls from either parents or front-line health care providers.
According to the 2017 report data, more than 24% of human exposure calls came to poison control centers from health care facilities. Huntington said in these situations, they are normally contacted by a treating physician or nurse and are making a recommendation on the patient’s care. But then there are times when a physician just wants confirmation and checks with poison control with a question.
Educating patients
Community pharmacists have an important role to play in providing poison prevention education to patients.
“Half of the calls we receive are related to kids,” said Huntington. According to the 2017 data, children younger than 6 years accounted for almost one-half (45%) of all human exposures managed by poison control. The data showed, however, that many of the more clinically serious cases occurred among teens and adults, a trend seen in previous years.
Medications should always be kept away from children and in a locked cabinet. Huntington said that it’s important to keep medications in their original packaging as well. This way, if a child does get into the medication and the parent calls poison control, there’s more information immediately accessible.
“Keeping [medications] away and knowing what they are is always good advice to give parents and patients,” said Huntington.
Studies have found that poison control centers can be effective in reducing unnecessary emergency medical transport and treatment costs. A significant portion of the costs savings results from home observation that poison control can help with. However, in cases in which parents or caregivers don’t know what a child took, they are told to go to the emergency department.
Other common substances involved in poison exposures in children younger than 6 years are cosmetics and personal care products, cleaning substances, pesticides, and plants. Although many household products come with child-resistant packaging, pharmacists can remind parents and caregivers that not all products are childproof and that all products should still be stored safely away from small children.
According to the Handbook of Nonprescription Drugs: An Interactive Approach to Self-Care, 19th edition, pharmacists can also prevent therapeutic 10-fold error types of poisonings by always dispensing 1-mL oral syringes for prescription medications that are dosed in infants at less than 1 mL.
Older adults are also at risk for potential poisoning and adverse drug reactions because of the number of medications they often take. Pharmacists should continue to educate older adults about potential drug–drug, drug–food, and drug–alcohol interactions.
An online tool at poisonhelp.org can help patients, pharmacists, and other health care providers decide whether to call the poison control center.
Patients can also text “POISON” to 797979 to save the contact info for poison control in their phone.