2000.pdf

( Telephone: +3531 837 9964 / 809 2566 Introduction:
The Poisons Information Centre provides a national service to doctors and other
healthcare professions in Ireland. The Centre provides information on the
toxicity, features and management of poisoning from drugs, household products,
industrial chemicals, pesticides, plants and fungi. A limited service is provided to
the general public e.g. advice on the need for immediate medical attention, skin
and eye decontamination.
The Centre provides a 24-hour service. Between 8.00am and 10.00pmtelephone enquiries are answered by our own Poisons Information Officers.
Night-time calls were answered by the nursing staff on St. Michael’s Ward,Beaumont Hospital, until 30th April 2000. Since 1st May 2000 our night-time callshave been automatically diverted to the Welsh National Poisons Unit in Cardiff.
There are no additional costs to callers as the extra call charges are borne byBeaumont Hospital.
Records:
Written records are kept of all enquiries to the Centre. A standard call report
form is used to note details of telephone enquiries (Appendix 1). In the future we
may record our telephone enquiries. Details of all enquiries are registered on a
computer database (UKPID) and used to generate reports.
Selected enquiries are followed up (usually by telephone) to determine what
features the patient developed and the outcome of the case.
Staff:
3.5 Poisons Information Officers: Mr. John Herbert BSc.,Dip Med Tox Ms. Elaine Donohoe MScMs. Nicola Cassidy BSc.,MMedScMr. Fergal O’Connor BSc The Poisons Information Officers and Manager are all science graduates; somehave masters degrees or a post-graduate diploma in medical toxicology. Thedirector is a consultant anaesthetist in Beaumont Hospital.
All staff participate in continuing professional development by attending in-houseprogrammes, meetings of Specialists in Poisons Information in the UK andIreland, courses and conferences organised by the European Association ofPoisons Centres and Clinical Toxicology (EAPCCT).
Information Sources:
The Centre uses a variety of information sources including a paper database,
computer databases, textbooks, articles from the medical and scientific literature
and material safety data sheets provided by industry.
The computer databases include:
First tier database of the UK NationalPoisons Information Service (NPIS) Pesticides & Veterinary Products (UK) Poisons Plants of Great Britain and Ireland Enquiries:
The Centre received a total of 14,389 enquiries in 2000, a similar number to 1999
(14,654 enquiries). August and November were the busiest months (Figure 1).
2,808 of these calls were answered by the Cardiff Centre and are not included in
the following analysis.
Figure 1. Month of enquiry
12,031 enquiries were answered by our own Poisons Information Officers.
Approximately, 34% of these enquiries were from Dublin (city and county), 10%were from Cork, 5% from Galway and 4% from Limerick (Table 1).
Origin of enquiries
County / Country
Number of enquiries
Origin of Calls:
Most enquiries were from doctors and nurses (Figure 2). 2,176 calls (18%) were
from members of the public.
Figure 2. Enquirers
11,327 (94%) enquiries concerned human cases of poisoning, 107 animals, and597 were non-emergency requests for information.
Human Cases of Poisoning:
4,347 (38.4%) enquiries involved children under 10 years and most of these wereunder 5 (Table 2). 4,191 (37.0%) enquiries were about adults (≥ 20years).
Males outnumbered females in the children between 1 and 9 years old. In theolder cases there was a predominance of females, particularly in the 15-19 yeargroup.
Age and sex of human cases
Age (years)
F:M Ratio
Agents:
The 11,325 enquiries about human cases involved 16,078 substances. As in
previous years most cases involved drugs, industrial chemicals or household
products (Table 3). Drugs were most frequently ingested by all age groups.
However, the majority of cases involving household products, cosmetic and
personal hygiene products and plants were children under 10 years.
Table 3 Agents in human cases
Age (years)
Children (< 10 years):4,347 enquiries, involving 4,358 products, were about children under 10 years.
Drugs, household products and cosmetics and personal hygiene products weremost frequently involved. The most common drugs were analgesics, vitamins,psycholeptics and cough and cold preparations.
Most common drugs in paediatric cases.
treatment of peptic ulcerAntianaemic preparations Adolescents (10 – 19 years)1,188 enquiries, involving 1,893 products, concerned adolescents. Drugs,industrial chemicals and household products were most frequently involved.
The most common drugs were analgesics, psycholeptics, psychoanaleptics andanti-inflammatory and antirheumatic drugs.
Most common drugs in adolescents
antirheumaticsStomatological preparations Adults (≥ 20 years)4,191 enquiries, involving 7,807 products, concerned adults. Drugs, industrialchemicals and household products were most frequently involved. The mostcommon drugs were psycholeptics, analgesics, psychoanaleptis and anti-inflammatory and antirheumatic drugs.
Most common drugs in adults
Outcome122 cases were followed up and 97 (79.5%) of these recovered completely, 16cases suffered sequelae and 9 patients died.
Other Activities
Quality management
The Centre introduced a system for peer review in January 2000. The written
records of all calls are reviewed by another Poisons Information Officer to ensure
that the form is completed properly and to check the advice given. During the
day when several Poisons Information Officers are on duty forms are reviewed
within one hour. Calls taken in the evening (6.00pm–10.00pm) are reviewed the
following morning. Protocols were written for all our activities and will be
reviewed/updated regularly.
Antidotes ListThe antidotes list was reviewed and the updated version circulated to hospitalpharmacies.
• John Herbert obtained the Postgraduate Diploma in Medical Toxicology from the University of Wales in June 2000.
• Nicola Cassidy commenced the Beaumont Hospital staff development programme. As part of this programme she undertook a project to develop aleaflet on the prevention of accidental poisoning.
• Elaine Donohoe and John Herbert took the Beaumont Hospital customer care course. Remaining staff will take this course in 2001.
• Elaine Donohoe, Nicola Cassidy and Dr. Joseph Tracey attended the EAPCCT Congress in Amsterdam in May 2000. Elaine attended a one-daysymposium prior to the Congress, Continuing Education in ClinicalToxicology.
Lectures/presentations• Patricia Casey lectured on the management of poisoning to emergency medical technicians, A&E nurses, CCU nurses and anaesthetists on severaloccasions in 2000 • Elaine Donohoe presented a poster on the impact of restrictions on the sale of paracetamol and Nicola Cassidy presented a poster on the effect of thenation-wide nurse’s strike on telephone enquiries to the NPIC at the EAPCCTmeeting in Amsterdam.
• Dr. Tracey gave a lecture on “Acute Poisoning” for the final of the FCA COUNTY/COUNTRY
Meeting Board National Poisons Information Lecture "Acute Poisoning" Final FCA course T.W. Holohan, C.P. Humphreys, H. Johnson, P.B. Casey, J.A. Tracey, M.
Laffoy, A.T. Clarke.
Sources of Information for Acute Poisoning in Accident and EmergencyDepartments in Dublin, Ireland.
Journal of Toxicology Clinical Toxicology 2000; 38: 29-36 P.A. McCormack, P.B. Casey, P. Barry, M. Laffoy, J. A. Tracey.
Delays in administration of acetylcysteine in paracetamol overdose.
Irish Medical Journal 2000; 93: 77-78 E. Donohone, J.A. TraceyRestrictions on Sale of paracetamol in Ireland had no impact on thenumber of tablets ingested in acute deliberate overdose.
Journal of Toxicology Clinical Toxicology 2000; 38:251 N. Cassidy, P.B. Casey, J.A. TraceyImpact of a nationwide nurses strike on telephone enquiries to theNational Poisons Information CentreJournal of Toxicology Clinical Toxicology 2000; 38: 239.
Appendix 2. Top 100 enquiries
AGENT NAME
GENERIC NAME
FlunitrazepamMethadoneAmitriptylineDimotapp Elixir Paediatric Phenylpropanolamine, phenylephrine,brompheniramine Essential OilInformationBleach HouseholdPetroleum Spirit HeroinMarihuanaLithium carbonateSilica GelVentolin Karvol Inhalant CapsulesZip FirelightersZyprexa Aftershave LotionAlkalisMilton Sterilising FluidPerfumeRound Up Benzodiazepine unknownParacetamol (Staggered Overdose)Risperidone

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