All things are poison. It is only the dose that differentiates a poison from a remedy.” – Paracelsus (1493-1541)
Yes, but what’s the crucial dose? The Specialists in Poison Information at the Missouri Poison Center are ready to figure that out.
Difficult or Unusual Cases
The Missouri Poison Center (MPC) can assist with acute or chronic drug exposures, including environmental or occupational cases. We have access to comprehensive databases and we stay current with the latest in toxicology through journals and other publications, by conference attendance, and by communicating with toxicologists around the world. If published research shows an improved treatment, our recommendations reflect that.
Our Specialists in Poison Information (SPIs) must pass a rigorous certifying exam and then recertify every seven years. Our scores rank top in the nation. We can help assess the situation of your patient and help plan a course of treatment. A toxicologist is available around the clock for physician-to-physician consultations. This consult can provide a safety net for risk management.
We want to do our part in containing health care costs. It means big savings when we can manage exposures at home rather than referring to emergency departments. Studies have shown that a poison center consult can help decrease the length of a hospital stay: 1.9 days average compared to 3.2 days.
The MPC participates in ongoing surveillance by continuous reporting to the National Poison Data System (NPDS). NPDS, the most comprehensive poison exposure surveillance database, provides a readily searchable, near real-time snapshot of conditions nationwide.
NPDS uses its data to identify trends and emerging public health concerns across the country. It can help identify and track food-borne illness, guide research, and detect chemical or bioterrorism incidents. Key regulatory agencies including the Centers for Disease Control, Food and Drug Administration, Environmental Protection Agency, Consumer Product Safety Commission and the Drug Enforcement Agency rely on NPDS data, along with the pharmaceutical industry. In the recent past, this type of information enabled removing some arsenic-containing rodenticides from the market and helped discover certain artificial nail products’ toxicity — leading to their being pulled from the shelves. We’ve received calls from NPDS officials asking about potentially threatening pesticide cases started within the previous hour. The more cases reported to the national database, the more meaningful the data. The MPC encourages clinicians to report adverse medication reactions, poisoning and overdose cases. For a routine poisoning that does not require a consultation, we are happy to include it in the NPDS database. Every case is important to help us track and evaluate trends in poisoning and identify public health threats in our communities.
What About Confidentiality?
The MPC documents all exposure reports in a confidential database subject to current regulations. The data is electronically submitted to the NPDS database without patient identifiers.
Why So Many Questions?
It helps to have an overall picture, which we can only get from your description over the phone, and sometimes we need specifics. The MPC wants to provide recommendations tailored to your patient. Since a patient history isn’t always accurate, clinical details help us understand the situation and pinpoint what we could do to help. Also, we might be able to assist in preventing further toxicity from a drug—drug interaction.
We give treatment recommendations to physicians, nurses, physician assistants, nurse practitioners, or paramedics. We can send a treatment guideline first, if necessary, but before too long we’ll want to speak with someone who knows about the patient.
Why the Follow-Ups?
The MPC offers a follow-up on all home exposures — to reassure the caller, to make sure the situation resolves as expected, and to be certain our teaching was understood. We want to manage as many cases at home as safely possible, so these follow up calls can reassure us too. If you would like, the specialists on the hotline can follow up on your discharged poisoned patients.
The MPC follows all patients managed in a health care facility — to reassess patient status and response to therapies, and to answer any questions that may arise. Since poisoning is a dynamic process, histories and patient status can change rapidly. Ideally, we like to speak to staff with firsthand knowledge. When we call, we try to limit it to a few essential questions, so that you can get on to other things. We want the best outcomes for your patients, so for quality assurance we need to ensure that we gave the best recommendations. Your toxicology consult is a safety net to risk management.
Another reason to follow up is documenting a known outcome. We appreciate your help in providing us with clinical details to be included in the NPDS database.
Please Have Ready When You Call (if possible):
— Details about the substance involved
— Estimated time of exposure
— An age and name of the patient
— Vital signs and symptoms
— A general idea of background or circumstances
If you have to run, just say so. We can talk to you later.
The Missouri Poison Center is only as strong as our hospitals, so please let us hear from you, and help us help our community.