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) Decatur 17 (3472) Norton 29 (5953) Phillips 37 (6001) Smith 19 (4536) Jewell 19 (3791) Republic 25 (5835) Washington 29 (6483) Marshall 51 (10965) Nemaha 70 (10717) Brown 79 (10724) Doniphan 29 (8249) Sherman 36 (6760) Wallace 7 (1749) Greeley 10 (1534) Hamilton 12 (2670) Stanton 9 (2406) Wichita 12 (2531) Kearney 23 (4531 ) Grant 46 (7909) Thomas 41 (81 80) Logan 19 (3046) Scott 26 (51 20) Finney 164 (40523) Haskell 25 (4307) Sheridan 12 (2813) Gove 22 (3068) Lane 8 (2155) Gray 37 (5904) Graham 18 (2946) Trego 14 (3319) Ness 12 (3454) Hodgeman 12 (2085) Ford 123 (32458) Rooks 28 (5685) Ellis 146 (27507) Rush 17 (3551) Pawnee 54 (7233) Edwards 18 (3449) Kiowa 24 (3278) Osborne 15 (4452) Russell 47 (7370) Barton 135 (28205) Stafford 31 (4789) Pratt 73 (9647) Mitchell 48 (6932) Lincoln 14 (3578) Ellsworth 26 (6525) Rice 58 (10761) Reno 388 (64790) Kingman 51 (8673) Cloud 72 (10268) Ottawa 45 (61 63) Saline 374 (53597) McPherson 225 (29554) Harvey Clay 66 (8822) Dickinson 120 (19344) Marion 60 (13361) Morris 39 (6104) 209 (32869) Allen Greenwood Woodson 59 (7673) 17 (3788) Sedgwick 3161 (452869) Riley 338 (62843) Geary 303 (27947) Butler 435 (59482) Pottawatomie 142 (18209) Chase 15 (3030) Wabaunsee 35 (6885) Lyon 208 (35935) Elk 17 (3261) Jackson 98 (12657) Shawnee 1500 (169871) Osage 108 (16712) Coffey 68 (8865) Wilson 59 (10332) Atchison 139 (16774) Jefferson 120 (18426) Douglas 684 (99620) Franklin 21 0 (24784) Anderson 60 (8110) 145 (14385) Neosho 146 (16997) Leavenworth 495 (68691 ) Wyandotte 851 (1 57882) Johnson 3857 (451086) Miami 21 7 (28351 ) Linn 54 (9570) Bourbon 97 (15379) Crawford 275 (38242) Morton 24 (3496) Stevens 33 (5463) Seward 123 (22510) Meade 21 (4631 ) Clark 16 (2390) Comanche 8 (1 967) Barber 27 (5307) Harper 33 (6536) Sumner 209 (25946) Cowley 202 (36291 ) Chautauqua 27 (4359) Montgomery 231 (36252) Labette 180 (22835) Cherokee 100 (22605) Human Exposure Counts 1-10 11-50 51-100 101-300 300 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. page 4 page 5
Poison Management KUHPCC is an integral part of the emergency medical system, providing a 24-hour hotline accessible to all of Kansas. 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. Top 10 Poison Exposure Substances Antihistamines Pesticides Antidepressants Foreign bodies Top 10 Poison Exposure Substances in Children < 6 Years Antihistamines GI Preparations Analgesics Cosmetics Cleaning Supplies Sedative/Hypnotic Topicals Cough and Cold Cosmetics Cleaning Supplies 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. 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 Per State Calls By Site Restaurant Missouri Other Kansas Own Residence Other Residence Workplace Health Care Facility 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. Analgesics Topicals Cough and Cold Foreign Bodies School Public Area Pesticides page 6 Vitamins page 7
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 page 8 page 9
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