The University of Kansas Hospital Poison Control Center Annual

The University of Kansas Hospital
Poison Control Center
Annual Report 2008
The University of Kansas Hospital Poison Control Center
3901 Rainbow Boulevard, Kansas City, KS 66160
1-800-222-1222
kumed.com/poison
Mission
The Mission of The University of Kansas Hospital Poison Control
Center is to provide immediate comprehensive patient treatment
information on toxic exposures, while trying to reduce future
poisonings through educational outreach.
Vision
• To serve the people of Kansas as a distinguished and unbiased
advocate for the promotion of public health
• To provide comprehensive educational outreach programs
on poison safety as well as treatment
• To partner with the health care facilities and caregivers in Kansas
for best patient outcomes with toxicological emergencies
• To serve the state by providing immediate treatment information on
biological, chemical or radiological exposures in the event of a
mass-casualty incident
Goals
1. Offer unimpaired access to quality poison control services for all
Kansans, 24 hours a day, 365 days a year
2. Assist with the early detection and elimination of potential poison
hazards utilizing the center’s real-time surveillance capabilities
3. Provide the state with immediate toxicological expertise needed in
mass-casualty incidents involving chemicals, biological or radiological
hazards
4. Enhance public awareness of the role of KUHPCC in poison
prevention and safety
5. Expand poison control services to decrease unnecessary use of
health care facilities for poison exposures
Introduction
The University of Kansas Hospital Poison Control Center (KUHPCC), formerly Mid-America Poison Control
Center (MAPCC), is a 24-hour health care information resource serving the state of Kansas and the greater
Kansas City metropolitan area. Our poison control center was created by the vision of Representative Jessie
Branson and Wayne Snodgrass, MD, in 1982. These two individuals worked diligently to assure that Kansas
citizens had a place to call for information when their toddler’s natural curiosity and exploratory nature put
them in a dangerous situation. The center was established at the University of Kansas Medical Center with
assistance from McNeil Laboratories in anticipation that the center itself would eventually be funded by the
state of Kansas.
Now in its 26th year, KUHPCC remains a part of The University of Kansas Hospital’s Department of Pharmacy.
As part of the state’s only academic health care center, KUHPCC has access to a vast network of resources.
The University of Kansas Hospital and University of Kansas Medical Center have earned national recognition
for their advanced clinical care, leading-edge research and preeminent health education. It is through the
generosity of The University of Kansas Hospital that the poison control center has survived and flourished.
KUHPCC is a member of the American Association of Poison Control Centers. The staff works closely with
members of the campus community and various medical disciplines. Members of this community are
clinicians, educators and researchers who remain at the forefront in the treatment of illness and disease.
page 1
Services:
KUHPCC is a health care
resource for the people of
Kansas. There is no fee for
calling. Poison prevention
brochures, magnets and stickers
are available by request.
Hotline Contacts
Animal Exposures
Non-Healthcare Facility
Call Backs
Healthcare Facility Call
Backs
More than 41,335 total phone
contacts, including poison
control center callbacks, were
made in 2007.
Of the more than 27,000
incoming calls received, more
than 22,000 were human poison
exposure calls. KUHPCC staff
successfully managed 17,475
human exposures with treatment
recommendations and follow-up
calls with no need for medical
intervention. Serious exposures
were referred to a health
care facility or health care
professional. Safe and effective
treatment of poisoned victims
by telephone resulted in excess
of $4 million in avoided health
care costs to Kansans last year.
Personnel
The most valuable asset of
KUHPCC is the dedicated team
of health care professionals
whose combined expertise
provides the center’s current
high standard of care.
Our team of pharmacists,
critical care nurses and medical
toxicologists provides a wealth
of knowledge in hands-on care
of the poisoned patient. The
center employs a full-time
education coordinator
dedicated to outreach and
poison control center
awareness.
page 2
Staff members have shown
their professional commitment
and leadership by participating
in the following organizations:
• American Association of
Medical Toxicology
• American Association
of Pediatrics
• American Association of
Poison Control Centers
• American College of Applied
Toxicology
• American College of
Occupational Medicine
• Association of Occupational
and Environmental Clinics
• Governor’s Bioterrorism
Council
• Environmental Health
Hazards Work Group
• Kansas Pharmacists
Association
• Kansas Safe Kids
• Kansas Society of Health
System Pharmacists
The estimated cost avoidance of
patients is based on customer
service surveys, which indicate
more than 80 percent of callers
to the poison control center
would have sought medical care
in an emergency room, and the
remainder would have sought
care at a physician’s office for a
poison exposure.
The average cost of a selfreferred emergency room visit is
$300, and $50 for a self-referred
physician visit. The cost
avoidance estimates do not take
into consideration how many of
the callers who would have
sought medical attention in the
emergency room, also would
have called 911 for ambulance
transport.
Drug Information
Human Exposures
Poison Information
The $4 million also does not
reflect the cost of any treatment
or laboratory costs associated
with an emergency room visit.
It is impossible to determine
if increased calls to the center
are a result of increased public
awareness of our services, an
increased number of poisonings
within the state or decreased
public access to health
information in a time of crisis.
The increased call volume could
very well be a combination of
any or all of these factors.
Whatever the reason, the
number of calls to KUHPCC
continues to increase.
KUHPCC has continued to
receive an increase in the
volume of calls. The center
has shown an upward trend
for 26 years, and there is
indication that this trend will
continue in future years.
Yearly Exposure Calls
25,000
20,000
15,000
10,000
5,000
0
1991
1993
1995
1997
1999
2001
2003
2005
2007
page 3
2007 Human Poison Exposure Call Counts
Cheyenne
9 (3165)
Rawlins
11 (2966)
Sherman
36 (6760)
Wallace
7 (1 749)
Thomas
41 (81 80)
Logan
19 (3046)
Decatur
17 (3472)
Sheridan
12 (2813)
Gove
22 (3068)
Norton
29 (5953)
Graham
18 (2946)
Trego
14 (3319)
Phillips
37 (6001 )
Smith
19 (4536)
Rooks
28 (5685)
Ellis
146 (27507)
Osborne
15 (4452)
Russell
47 (7370)
Jewell
19 (3791 )
Mitchell
48 (6932)
Lincoln
14 (3578)
Ellsworth
26 (6525)
Greeley
10 (1534)
Wichita
12 (2531 )
Scott
26 (51 20)
Lane
8 (2155)
Ness
12 (3454)
Rush
17 (3551 )
Hamilton
12 (2670)
Hodgeman
12 (2085)
Finney
164 (40523)
Cloud
72 (10268)
Dickinson
120 (1 9344)
Stanton
9 (2406)
Grant
46 (7909)
Haskell
25 (4307)
Morton
24 (3496)
Stevens
33 (5463)
Seward
123 (22510)
Ford
123 (32458)
Kiowa
24 (3278)
Meade
21 (4631 )
Clark
16 (2390)
Comanche
8 (1 967)
Human Exposure Counts
1 - 10
Pratt
73 (9647)
Barber
27 (5307)
Atchison
139 (1 6774)
Shawnee
1500 (169871 )
Wabaunsee
35 (6885)
Geary
303 (27947)
Marion
60 (13361)
Reno
388 (64790)
Chase
15 (3030)
Coffey
68 (8865)
Sedgwick
31 61 (452869)
Greenwood
59 (7673)
Wilson
59 (10332)
Kingman
51 (8673)
Harper
33 (6536)
11 - 50
Woodson
17 (3788)
51 - 100
Cowley
202 (36291 )
101 - 300
Chautauqua
27 (4359)
Montgomery
231 (36252)
Miami
21 7 (28351 )
Anderson
60 (8110)
Linn
54 (9570)
Allen
145 (1 4385)
Bourbon
97 (15379)
Neosho
146 (1 6997)
Elk
17 (3261 )
Sumner
209 (25946)
Wyandotte
851 (1 57882)
Johnson
Douglas
684 (99620) 3857 (451086)
Franklin
21 0 (24784)
Harvey
209 (32869)
Butler
435 (59482)
Leavenworth
495 (68691 )
Osage
108 (1 6712)
Lyon
208 (35935)
McPherson
225 (29554)
Doniphan
29 (8249)
Jefferson
120 (1 8426)
Morris
39 (61 04)
Pawnee
54 (7233)
Stafford
31 (4789)
Brown
79 (10724)
Jackson
98 (12657)
Riley
338 (62843)
Ottawa
45 (61 63)
Edwards
18 (3449)
Gray
37 (5904)
Pottawatomie
142 (1 8209)
Clay
66 (8822)
Saline
374 (53597)
Nemaha
70 (1071 7)
Marshall
51 (10965)
Washington
29 (6483)
Barton
135 (28205)
Rice
58 (10761)
Kearney
23 (4531 )
Republic
25 (5835)
Labette
180 (22835)
Crawford
275 (38242)
Cherokee
100 (22605)
300 and above
Label sample : 10 (1000) represents 10 total human exposure calls from county population of 1,000
In 2007, KUHPCC received calls from all 105 counties in Kansas.
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Poison Management
KUHPCC is an integral part of
the emergency medical system,
providing a 24-hour hotline
accessible to all of Kansas.
Top 10 Poison Exposure Substances
Antihistamines
Antidepressants
Using comprehensive reference
systems, poison information
specialists quickly determine
the proper treatment for
exposure to any poisonous
substance. Exposure may occur
by inhalation, ingestion,
injection, or direct contact to
eyes or skin. Emergency firstaid measures and treatment
recommendations are provided
by telephone immediately.
When a poisoning cannot be
treated at home, specialists
arrange referral to the nearest
emergency department for
evaluation and treatment. A
medical toxicologist is available
24 hours a day to the staff
and health care providers of all
emergency departments for
treatment of serious exposures.
During 2007, KUHPCC
managed 21,100 human poison
exposures. Prescription and
non-prescription drugs
accounted for 54 percent of
these exposures. Household
products, plants, animal
envenomation and industrial
products were other sources for
poison exposures.
Analgesics
Cosmetics
Cleaning Supplies
Sedative/Hypnotic
Topicals
Cough and Cold
Foreign bodies
Pesticides
Top 10 Poison Exposure
Substances in Children < 6 Years
Antihistamines
GI Preparations
Cosmetics
During 2007, 3,515 calls were
received from health care
professionals throughout the
state, requesting consultation
regarding treatment of poison
exposures and overdoses. The
resources and expertise of
KUHPCC provided health care
professionals with the most
accurate treatment information
regarding toxic exposures.
Calls Per State
Missouri
Other
Kansas
As the only poison control
center in Kansas, KUHPCC
provides access to all residents
of the state via toll-free
telephone lines. In addition,
the center received calls from
39 other states in 2007.
Calls requesting poison and
drug information also are
received by the center. In 2007,
KUHPCC received more than
1,450 calls dealing with general
poison information, 2,320 calls
pertaining to drug information
and identification, and 790
calls regarding animal
poisonings. These calls provide
the staff an opportunity to
convey important information
about poisons and toxic
exposures, and are a significant
component of the educational
programs of KUHPCC.
Calls By Site
Restaurant
Own Residence
Other Residence
Workplace
Health Care Facility
Cleaning Supplies
Analgesics
Poisoning is the number one
public health hazard among
young children. Approximately
64 percent of the poison
exposures managed by
KUHPCC specialists during the
last year occurred in children
less than six years of age.
Topicals
Cough and Cold
School
Public Area
Foreign Bodies
Pesticides
Vitamins
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Goals for 2008
It is anticipated that the
number of calls will continue
to increase to KUHPCC in the
future. This is especially true
as our education outreach
expands and the public
becomes more aware of the
services we provide. Thus, we
are developing strategies for
improving our services to
provide optimum care to
the people of Kansas.
1. To keep up with current
knowledge, staff members are
encouraged to attend various
professional meetings and
continuing education
programs. The staff is also
encouraged to submit abstracts
for posters or presentations
to both state and national
meetings. The funding to
support these activities has
been a limiting factor.
2. In order to maintain the
current level of service and
to increase our visibility
throughout the state of Kansas,
provisions must be made in the
budget to accommodate the
increased demand. An increase
in calls has resulted in an
increase in expenses for
maintaining the state and
national 800 toll-free
telephone lines, as well as an
increased demand for printed
materials.
Funds to meet the needs for
these added expenses could be
found in grants and donations
from corporations, state funds
and outside charity sources.
3. It is becoming more of
a financial hardship on
uninsured/underinsured
Kansans to access health care
information over the phone.
Treatment
Utilizing a comprehensive
computerized reference system,
resource books, research
literature and toxicological
concepts, specialists can quickly
determine and recommend the
proper treatment for exposures
to more than a million toxic
substances.
If there is a change in a patient’s
status, the specialist modifies
the treatment plan accordingly.
Follow-up also provides the
opportunity for the poison
specialist to discuss poison
prevention with callers after
the poison exposure has been
resolved.
Follow-up
Thankfully, the majority of cases
followed by the poison control
center in 2007 had no lasting
effects. Regretfully, not all
poisonings have optimal
outcomes.
The center followed seven cases
in Kansas that resulted in death.
Since not all poisonings or
overdoses are required to be
reported to the poison control
center, it is reasonable to assume
that deaths from toxic exposures
could be far more significant
than our data indicates.
Medical Outcomes
No Effect
Follow-up is the key to successful
treatment of poison victims.
Close follow-up enables the
specialist to monitor the
treatment and its optimal
outcome.
Minimally Toxic
As telephone access to health
information decreases, the
poison control center remains
an immediately available free
resource to the public for
poison and drug information.
The goal to educate the public
on the safe use of medications
and chemicals can be achieved
by continuing to increase
KUHPCC’s visibility
throughout the state of Kansas.
Professional and public
education requests increase
with visibility of the poison
control center director and
the education coordinator.
It continues to be a challenge
for the center to meet the
demand with one public
educator and one
professional educator.
Kansas is the 13th largest state
in the nation in land area.
The cost of traveling to areas
throughout the state has risen
dramatically. There is a need to
increase the budget to continue
to meet the requests and needs
for such programs. Grants
through the Kansas
Department of Health and
Environment help to fund
some of the educational
program expenses. Health
departments throughout the
state provide a valuable
resource for the center in
public education. The center is
looking for avenues of support
through charities, donations
and in-kind support for these
activities.
Death
Major Moderate Minor
Not Toxic
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Public and Professional Education
Financial Review
The budgetary requirements
for KUHPCC continue to
increase as salaries, phone
charges and supply costs
increase.
The majority of funding for
KUHPCC is through The
University of Kansas Hospital.
page 10
The center receives grants
from the federal government,
administered by the Health
Resources and Services
Administration (HRSA), a
department of Health and
Human Resources, as well
as from the Kansas Department
of Health and Environment
(KDHE).
These grants are used to help
offset the financial burden
placed on one hospital.
Public
Professional
KUHPCC continues to develop
new approaches to educating
the general public about poison
prevention. The poison
information materials have
been upgraded, and more than
140,000 pieces of poison
information material were
distributed in 2007. Numerous
programs on poison prevention
were presented to various groups
throughout the state of Kansas.
The role of the education
coordinator is to increase the
awareness of KUHPCC
throughout the state, and to
promote poison prevention to
the general public. The KUHPCC
educator has established a
significant presence throughout
the state, while striving to find
innovative means of providing
poison safety information to the
public. KUHPCC has established
a working rapport with health
departments within the state.
Involvement with state programs,
such as Kansas Safe Kids and
other programs through the
Kansas Department of Health
and Environment, provides
further educational opportunities. The education coordinator
serves as the public information
contact for the center.
KUHPCC continues to provide
leadership in the education of
health care professionals in the
field of toxicology in the state of
Kansas.
A. Post-graduate
education
Master’s candidates
in Pharmacy Practice
Management
Each resident is given the option
of a toxicology rotation with
KUHPCC. Emphasis includes
clinical toxicology, research
opportunities and management
of poison exposures. Candidates
are required to staff all shifts
along with a CSPI during their
rotations.
Doctors of Pharmacy (PharmD)
– Clerkship Rotations
This is an elective clerkship in
the PharmD program offered
by KUHPCC. The emphasis is
similar to the master’s candidate
rotation, with an emphasis on
mechanism of toxicity and
treatment of poisoned patients.
B. Undergraduate
education
Shadowing
Pharmacy students are given the
opportunity to shadow a poison
information specialist for
four hours so they can better
understand the role pharmacists
have in this area of practice.
Lectures
The poison control center
director and medical director
provide lectures to the School
of Pharmacy toxicology classes.
Lectures also are provided to the
third-year medical students and
first-year pediatric residents
at the University of Kansas
Medical Center. It is anticipated
the Schools of Nursing and
Medicine will benefit from
lectures by KUHPCC staff in
the years to come.
page 11
Medical Toxicologists
Adam Algren, MD
Jennifer Lowry, MD, Medical Director, Clinical Pharmacologist
Gary Wasserman, DO, FACMT
Education Coordinator
William “Daling” McMoran
Poison Information Specialists
Amber Ashworth, RN, SPI
Anne Marie Banks, RN, SPI
April Beaty, RN, BSN, SPI
Anita Johansson, RN, BSN, CSPI
Greta O’Brien, RN, SPI
Lisa Oller, RPh, CSPI
Elizabeth “Tina” Scott, RN, BSN, CSPI
Bobbi Wainscott, RN, BSN, CSPI
Pharmacy Student Interns
Jeff Little
Victoria Nguyen
Director’s Message
page 12
KUHPCC is in its 26th year of
operation. The center has
expanded from an eight-hour-aday service with 1.5 full-time
employees and 10 calls per day
to the present 24-hour service
with 10 full-time employees
and approximately 100 calls per
day. The focus of the program
also has expanded.
The center is reaching out to
the aging adults of Kansas as
this group takes the largest
number of daily medications.
Although accidental childhood
poisonings continue to be our
major focus, environmental
and occupational poisoning
in the adult population is
becoming more common.
Substance abuse is a growing
problem within the state
among teens and young adults.
The medications taken by
this population can be deadly
to children and have serious
effects on the adult who
accidentally duplicates a dose.
As new, more potent chemicals
or drugs emerge and are
utilized within our society,
the complexity of managing
exposures is more involved.
KUHPCC works tirelessly to
remain at the leading edge of
the ever-expanding field of
toxicology.
Managing Director
Tama Sawyer, PharmD, DABAT