2013 annual report - Whitepages€¦ · 2013 annual report New South Wales Poisons Information...
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2013 annual report New South Wales Poisons Information Centre 13 11 26 Corner Hawkesbury Road and Hainsworth Street Locked Bag 4001 Westmead NSW 2145 Tel +61 2 9845 0000 Fax +61 2 9845 3489
Transcript of 2013 annual report - Whitepages€¦ · 2013 annual report New South Wales Poisons Information...
2013 annual report
New South Wales
Poisons Information Centre
13 11 26
Corner Hawkesbury Road and Hainsworth Street
Locked Bag 4001 Westmead NSW 2145
Tel +61 2 9845 0000 Fax +61 2 9845 3489
Table of Contents
2013 Staff Members ............................................................................................................................ 3
Service Details ..................................................................................................................................... 4
Publications ........................................................................................................................................ 4
Toxicovigilance activities ................................................................................................................... 10
Clinical governance and quality assurance activities .......................................................................... 10
Calls received per month for 2013 and 2012 ...................................................................................... 11
Victims of poisoning .......................................................................................................................... 11
Call Characteristics ............................................................................................................................ 12
Route of Exposure ............................................................................................................................. 12
Persons calling the Poisons Information Centre ................................................................................. 13
Hourly call breakdown ...................................................................................................................... 13
Histogram based on time of calls ....................................................................................................... 14
Handling of Calls – Adult ................................................................................................................... 14
Handling of Calls – Child (<18 years) .................................................................................................. 15
Age in Years of Children .................................................................................................................... 16
Calls based on Gender ....................................................................................................................... 16
Call type ............................................................................................................................................ 17
Types of exposure ............................................................................................................................. 17
Types of queries ................................................................................................................................ 17
Calls referred from health phone triage services ............................................................................... 18
Substances which generate the most calls ......................................................................................... 18
Summary of calls referred to medical consultants ............................................................................. 18
NB: Future annual reports will be reported on a financial year basis, starting from 1 July 2014 – 30 June 2015. An interim 6-month report for 1 January – 30 June 2014 will also be produced.
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2013 Staff Members
Administration
A/Prof Naren Gunja, MB BS, MSc, FACEM, FACMT Medical Director
Prof Andrew Dawson MB BS, FRACP, FRCP (Edin) Senior Staff Specialist (Education)
Prof Nicholas Buckley MD, FRACP Senior Staff Specialist (Research)
Judith Kirby, B Pharm Manager (part-year)
Christa Lynch, B Pharm Manager (part-year) and Deputy Manager (part-year)
Lorraine Lum Secretary
Senior Poisons Specialists
Jared Brown, B Pharm (Hons), MPH, GradDipClinEpi (Clin Tox)
Research and Audit Christine Cantlay, B Pharm
Recruitment Lorette Mack, B Pharm
Training Bina Sira, B Sc (Hons)
Standards
Additionally, 14 other poisons information specialists were involved in handling phone calls, most are pharmacists and three are medical scientists.
Medical Consultants
Dr Sam Alfred MB BS, FACEM Dr Jason Armstrong, MB BS, FACEM Dr Betty Chan, MB BS, FACEM, PhD Prof Nicholas Buckley, MD, FRACP
Dr Michael Downes, MB ChB, FACEM Dr Robert Dowsett, MB BS, FACEM
Prof Andis Graudins, MB BS PhD FACEM FACMT Dr Shaun Greene, MB ChB, MSc (Med Tox), FACEM
Dr Geoffrey Isbister, B Sc, MB BS, MD, FACEM Dr Zeff Koutsogiannis, MB BS, FACEM
Dr Mark Little, MB BS, FACEM, MPH&TM, DTM&H (Lon) Dr David McCoubrie, MB BS, FACEM
A/Prof Lindsay Murray, MB BS, FACEM Dr Colin Page, MBChB, FACEM, M Med Sc (Clin Epid)
Dr Jessamine Soderstrom, MB BS, FACEM
Fellows in Training
Dr Angela Chiew BSc (Med), MB BS (Hons), FACEM Dr Dino Druda B Med Sc (Hons), MB BS, MRCP(UK),
FACEM, Grad Dip Clin Tox Dr Dushan Jayaweera MB BS (Hons), FACEM, Dip Tox
Dr Satish Mitter MB BS, FACEM, Dip Tox
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Service Details Hours of Operation The New South Wales Poisons Information centre forms part of a national network of Poisons Information Centres that provides 24 hours per day, seven days a week coverage, including all holidays. Telephone Access The Poisons Information Centre can be reached on 13 11 26 which gives callers access to the Centre from anywhere in Australia for the cost of a local call (excluding mobile phones). Medical Consultants Medical Toxicology Consultants are provided to physician callers for unusual, complicated or severe poisoning cases. Each day, coverage is provided for both adult and paediatric poisonings. (This service is available 24 hours per day).
Publications The NSW Poisons Centre is in a unique position to be able to collect data and co-ordinate research into clinical toxicology particularly for rare poisonings and poisoning involving agents newly introduced to the market. These activities contributed to the following publications during 2013: Journals 1. Rajapakse B, Neeman T, Dawson AH The effectiveness of a 'train the trainer' model of
resuscitation education for rural peripheral hospital doctors in Sri Lanka. Plos One November 2013 DOI: 10.1371/journal.pone.0079491
2. Pearson M, Zwi AB, Buckley NA, Manuweera G, Fernando R, Dawson AH, McDuie-‐Ra D. Policymaking 'under the radar': A case study of pesticide regulation to prevent intentional poisoning in sri lanka. Health Policy Plan 2013, Dec 20.
3. Senarathna L, Buckley NA, Dibley MJ, Kelly PJ, Jayamanna SF, Gawarammana IB, Dawson AH. "Effect of a Brief Outreach Educational Intervention on the Translation of Acute Poisoning Treatment Guidelines to Practice in Rural Sri Lankan Hospitals: A Cluster Randomized Controlled Trial." PloS one 8, no. 8 (2013): doi:10.1371/journal.pone.0071787.
4. Weerasinghe M, Pearson M, Peiris R, Dawson A.H, Eddleston M, Jayamanne S, Agampodi S, Konradsen F The role of private pesticide vendors in preventing access to pesticides for self-‐poisoning in rural Sri Lanka. Injury Prevention (June 2013)
5. Senarathna L, Hunter C, Dawson A.H, Michael J. Dibley MJ Social Dynamics in Sri Lankan Rural Hospitals: Revelations from Self-‐poisoning Cases. Qualitative Health Research (October 2013)
6. Carter GL, Clover K, Whyte IM, Dawson A.H, D’Este C. 2013, Postcards from the EDge: 5-‐year outcomes of a randomised controlled trial for hospital-‐treated self-‐poisoning. British Journal of Psychiatry. 2013 May;202(5):372-‐80
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7. Buckley NA, Dawson A.H. The intralipid genie is out of the bottle-‐spin and wishful thinking. Anaesth Intensive Care. 2013 Mar;41(2):154-‐6
8. Basher A, Rahman SH, A. Ghose A, Arif SM, M. A. Faiz MA, Dawson, A.H., 2013, Phase II study of Magnesium Sulfate in acute Organophosphate pesticide poisoning Clinical Toxicology (Philadelphia, Pa.), 51(1), pp 35–40
9. Dawson, A H, and M F Wilks. "With the Benefit of Hindsight: Trials Using Retrospective Controls Versus Randomized Controlled Trials in Clinical Toxicology." Clinical toxicology (Philadelphia, Pa.) (2013)doi:10.3109/15563650.2013.821130.
10. Dawson, AH. "Comment on Editorial; Best Research for Low Income Countries." Asia Pacific Journal of Medical Toxicology 2, no. 2 (2013): 76
11. Johnston CI, Brown SG, O'Leary MA, Currie BJ, Greenberg R, Taylor M, Isbister GK; for the ASP investigators. Mulga snake ( Pseudechis australis ) envenoming: a spectrum of myotoxicity, anticoagulant coagulopathy, haemolysis and the role of early antivenom therapy – Australian Snakebite Project (ASP-‐19). Clinical Toxicology 2013; 51(5):417-‐24.
12. Gulati A, Isbister GK, Duffull SB. Effect of Australian elapid venoms on blood coagulation (ASP-‐17). Toxicon 2013; 61C:94-‐104.
13. Cubitt M, Armstrong J, McCoubrie D,White J, Williams V, Isbister GK. Point-‐of-‐care testing in snakebite. Emergency Medicine Australasia 2013;25:372–374.
14. Pearson M, Zwi AB, Manuweera G, Buckley NA, Fernando R, Dawson AH, McDuie-‐Ra D. Policymaking ‘under the radar’: a case study of pesticide regulation to prevent intentional poisoning in Sri Lanka. Health Policy and Planning 2013; Dec 20. [Epub ahead of print] IF:3.056
15. Isbister GK, Buckley NA, Page CB, Brown SGA. A randomised controlled trial of fresh frozen plasma for venom induced consumption coagulopathy in Australian snakebite (ASP-‐18). Journal of Thrombosis and Haemostasis 2013;11(7):1310-‐8. IF:6.081
16. Konickx LA, Worek F, Jayamanne S, Thiermann H, Buckley NA, Eddleston M. Reactivation of plasma butyrylcholinesterase by pralidoxime chloride in patients poisoned by WHO Class II toxicity organophosphorus insecticides. Toxicological Sciences2013;136(2):274-‐83. IF:4.7
17. Wunnapuk K, Liu X, Peake P, Gobe G, Endre Z, Grice JE, Roberts MS, Buckley NA. Renal biomarkers predict nephrotoxicity after paraquat. Toxicology Letters 2013;222:280-‐288. IF:3.145
18. Senarathna L, Buckley NA, Jayamanna SF, Kelly P, Dibley MJ, Dawson AH. Effect of a Brief Outreach Educational Intervention on the Translation of Acute Poisoning Treatment Guidelines to Practice in Rural Sri Lankan Hospitals: A Cluster Randomized Controlled Trial. PLoS ONE 2013;8(8): e71787. IF:3.730
19. Isbister GK, Maduwage K, Shahmy S, Scorgie F, O’Leary MA, Mohamed F, Abeysinghe C, Karunathilake H, Ariaratnam CA,Buckley NA. Poor diagnostic utility of the 20 minute whole blood clotting test (WBCT20) for viper envenoming. Quarterly Journal of Medicine 2013; 106(10):925-‐32. IF:2.361
20. Roberts DM, Hall MJ, Falkland MM, Strasser SI, Buckley NA. Amanita phalloides poisoning and treatment with silibinin in the Australian Capital Territory and New South Wales. Medical Journal of Australia 2013;198(1):43-‐47. IF:2.853
21. Roberts D, Buckley NA. Paraquat/Diquat poisoning in: In: UpToDate, Basow, DS (Ed), UpToDate, Waltham, MA; latest version 23rd May 2013.
22. Isbister GK, Page CB, McCoubrie D, Green S, Brown SGA, Buckley NA. Treatment of snake bite in Australia: a practical approach to diagnosis and treatment. Medical Journal of Australia 2013;199:763–768. IF:2.853
23. Pianta TJ, Buckley NA, Peake PW, Endre ZH. The clinical use of biomarkers for toxicant-‐induced acute kidney injury (ToxAKI).Biomarkers in Medicine 2013; 7(3):441-‐56. IF: 3.217
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24. Buckley NA, Dawson AH. The intralipid genie is out of the bottle – Spin & wishful thinking. Anaesthesia Intensive Care2013; 41(2):154-‐156. IF: 1.396
25. Buckley NA, Faunce T. Trials and Tribulations in the Removal of Dextropropoxyphene from the Australian Register of Therapeutic Goods. Medical Journal of Australia 2013; 199(4):257-‐260. IF:2.853
26. Buckley NA, Whyte IM. Antivenom (snakebite treatment in rural and remote areas). Australian Prescriber 2013; 1:4. IF: 0.831
27. Buckley NA, Juurlink DN. Carbon monoxide treatment guidelines must acknowledge the limitations of the existing evidence.American Journal of Respiratory and Critical Care Medicine 2013; 187(12):1390. IF:11.041
28. Isbister GK, Buckley NA, Brown SGA. Tiger snake (Notechis spp) envenoming: Australian Snakebite Project (ASP-‐13). Medical Journal of Australia 2013;198(4):194-‐5. IF:2.853
29. Brown JA, Buckley NA. Carbon monoxide death and toxicity from charcoal briquettes. Medical Journal of Australia2013;198(2):86. IF:2.853
30. Brown JA, Buckley NA. Toxicity from bodybuilding supplements and ‘legal highs’ containing 1,3-‐dimethylamylamine (DMAA).Medical Journal of Australia 2013; 198(8):414-‐5. IF:2.853
31. Brown JA. Clinical Toxicology and Poisons Information Centres – an Australian pharmacist’s experience. Journal of Pharmacy Practice and Research. 2013; 43 (1): 81-‐2.
32. Brown JA. Medicinal mishap: incorrectly dropped in the eye. Australian Prescriber. 2013; 36 (2): 56-‐7.
33. Lubman D, Peacock A, Droste N, Pennay A, Miller P, Bruno R, Lloyd B, Hyder S, Roxburgh A, Wadds P, Tomsen S, Brown J. Alcohol and Energy Drinks in NSW. Turning Point Alcohol and Drug Centre, Melbourne. April 2013.
34. Li, E., Gunja, N. (2013). Illicit drug overdose -‐ Prevalence and acute management. Australian Family Physician, 42(7), 481-‐485.
35. Gunja, N. (2013). In the Zzz Zone: The Effects of Z-‐Drugs on Human Performance and Driving. Journal of Medical Toxicology, 9(2), 163-‐171.
36. Gunja, N. (2013). The Clinical and Forensic Toxicology of Z-‐drugs. Journal of Medical Toxicology, 9(2), 155-‐162.
Presentations 1. Dawson AH. Therapeutic implications of relative toxicity of SSRI and SNRI
antidepressants (Invited Speaker) Sri Lanka College of Psychiatrists Annual Academic Sessions. Kandy Sri Lanka, March 2 2013
2. Dawson AH. Establishing a Clinical Research Centre. (Invited Speaker) Asia Pacific Association of Medical Toxicology, Dubai, November 21 2013
3. Dawson AH. Opening our data. (Plenary Speaker) Asia Pacific Association of Medical Toxicology, Dubai, November 22 2013
4. Dawson AH. Tropical Toxicology. Invited Speaker. Social Media and Acute Critical Care Conference. Sydney May 2013
5. Dawson AH. Acute toxicology: potential roles in setting environmental priorities. Invited Speaker Korea International Union of Toxicology Congress June 2013
6. Dawson AH. Just how poisonous are SSRIs? Invited Keynote Copenhagen EAPCCT May 2013
7. Senarathna L, Guruge D, Gawararammana I, Bandara P, Dawson A. First aid practices for acute poisoning and snakebite patients in Sri Lanka-‐ findings from a community study. APAMT 12th Congress Dubai November 2013
8. Pushpakumar PHGJ, Tennakoon SUB, Adikari AMP, Dawson AH, Abeysinghe R. Impact of life-‐skills, help seeking ability nad mental health on acute deliberate self poisoning in
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Kurunegala District, Sri Lanka: A case control study. APAMT 12th Congress Dubai November 2013
9. Buckley N, Dawson A, Whyte I, Isbister G. 25 years of self-‐poisoning in Newcastle, 1987-‐2011. APAMT 12th Congress Dubai November 2013
10. Pathmeswaran A, Kasturiratne A, Gunawardena NK, Wijayawickrama BA, Jayamanne S, Isbister G, Dawson A, de Silva HJ. Community incidence of snakebite in Sri Lanka. APAMT 12th Congress Dubai November 2013
11. Senarathna L, Hunter C, Dibley M, Buckley N, Jayamanne S, Dawson A. percetption of community expectations blocks policy into practice translation in poisoning treatment in Sri Lankan rural hospitals. APAMT 12th Congress Dubai November 2013
12. Ariyananda P, Palangasinghe C, Perera B, Abeygunawardena D, Dawson A. prospective observational study of clinical features of adults with glyphospate poisoning in southern Sri Lanka. APAMT 12th Congress Dubai November 2013
13. Buckley NA. Beware of false dichotomies -‐ adopting quantified risk assessment into clinical toxicology practice. Asia Pacific Association of Medical Toxicology (APAMT) meeting, Dubai, November 2013.
14. Buckley NA. Problems with estimating the effectiveness of treatments for organophosphorus poisoning & Paraquat -‐ What to do? (seminar). Preventive Medicine, Korea University, Seoul. July 3rd, 2013.
15. Buckley NA. Paracetamol poisoning. SMACC Conference, Sydney, March 11-‐13 2013 16. Wijerathna PATM, Dissanayake D, Fahim M, Gawarammana IB, Buckley
NA. Identification of Novel Urinary Biomarkers as Surrogates of Acute Kidney Injury Following Human Self-‐Poisoning With a New Laundry Detergent In Southern Sri Lanka.Asia Pacific Association of Medical Toxicology (APAMT) meeting, Dubai, November 2013.
17. Fahim M, Gawarammana IB, Buckley NA. Mechanisms underlying early rapid increases in creatinine in paraquat poisoning. Asia Pacific Association of Medical Toxicology (APAMT) meeting, Dubai, November 2013.
18. Buckley NA, Dawson AH, Whyte IM, Isbister GK. Twenty five years of poisoning in Newcastle. Asia Pacific Association of Medical Toxicology (APAMT) meeting, Dubai, November 2013.
19. Konickx LA, Worek F, Jayamanne S, Thiermann H, Buckley NA, Eddleston M. Reactivation of plasma butyrylcholinesterase by pralidoxime chloride in patients poisoned by WHO Class II toxicity organophosphorus insecticides. Asia Pacific Association of Medical Toxicology (APAMT) meeting, Dubai, November 2013.
20. Isbister GK, Page CB, Buckley NA, Fatovich D, Pascu O, MacDonald S, Calver LA, Brown SGA. Randomised controlled trial of intravenous antivenom versus placebo for the treatment of latrodectism – the second redback antivenom evaluation (RAVE-‐ II) study. Asia Pacific Association of Medical Toxicology (APAMT) meeting, Dubai, November 2013.
21. Pearson SA, Abrahamowicz M, Srasuebkul P, Buckley N. Antidepressant treatment (ADT) following a cancer diagnosis: Investigation in a cohort of older patients. International Conference on Pharmacoepidemiology (ISPE) August 25-‐28, 2013, Montreal, Canada.
22. Langton JM, Srasuebkul P, Buckley N, Pearson SA. Medicines in the last 12 months of life: Observations in a cohort of elderly patients. International Conference on Pharmacoepidemiology (ISPE). August 25-‐28, 2013, Montreal, Canada.
23. Pianta TJ, Chin MT, Peake PW, Buckley NA, Pickering JW, Endre ZH. Plasma cystatin C is elevated in the absence of acute kidney injury following cisplatin with contemporary antiemetics. ANZSN 49th Annual Scientific Meeting. Nephrology2013; 18 (Supp. 1):41.
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24. Pianta TJ, Peake PW, Buckley NA, Kelleher M, Pickering J, Endre ZH. Urinary Clusterin Predicts graft Recovery Within Four Hours Of Transplantation. ANZSN 49th Annual Scientific Meeting. Nephrology 2013;18 (Supp. 1):43
25. Succar L, Peake PW, Pianta TJ, Buckley NA, Endre ZH. Urinary biomarker KIM-‐1 rises earlier than NGAL in experimental aristolochic acid nephropathy. ANZSN 49th Annual Scientific Meeting. Nephrology 2013;18(Supp. 1):53
26. Wunnapuk K, Mohammed F, Gawarammana I, Liu X, Verbeeck RK, Buckley NA, Roberts MS, Musuamba FT. Population analysis of paraquat toxicokinetics in poisoning patients. Population analysis group of Europe (PAGE) meeting Glasgow June 2013.
27. Mohamed F, Endre Z, Shihana F, Peake P, Buckley N. Novel acute kidney injury (AKI) biomarkers in early diagnosis of glyphosate surfactant herbicide (GSH) poisoning. World Congress of Nephrology. Hong Kong June 2013.
28. Chiew AL, Brown J, Chan BSH, Buckley NA. Puberty blues -‐ Copper salt exposures in Australian schools. European Association of Poisons Centres & Clinical Toxicology Scientific meeting, Copenhagen 2013. Clinical Toxicology 2013;51(4):360
29. Chan BSH, Chakir, B, Sivanesan A, Gunja N, Brown J, Buckley NA. Metformin induced lactic acidosis reported to the New South Wales Poisons Information Centre European Association of Poisons Centres & Clinical Toxicology Scientific meeting, Copenhagen 2013. Clinical Toxicology 2013;51(4):364.
30. Brown JA. Children and Medicine Adverse Events (invited speaker). NSW Pharmacy Guild National Convention and Exhibition, June 21-‐23 2013.
31. Green JL, Desel H, Milanesi G, Sesana F, Brown JA, Gunja N, Kupferschmidt H, De Vries I, Campbell A, Thomas SHL, Thompson JP, Severtson G, Poppish L, Gmerek B, Dart RC. Unintentional pediatric opioid exposures as reported to the Global Toxicosurveillance Network (GTNet) from 2008–2010. European Association of Poisons Centres and Clinical Toxicologists Congress, May 28-‐31 2013. Abstract available in: Green, et al. Clin Toxicol 2013;51:339.
32. Brett J, Brown JA, Dawson A. Clenbuterol toxicity: NSW Poisons Information Centre Experience (oral presentation). Toxicology and Poisons Network Australasia Scientific Meeting, May 2-‐4 2013.
33. Brown JA. Poisons centres and public health. Public Health Trainees Meeting, Sydney. 22 May 2013.
34. Gunja N. FACTA Conference, Sydney 2013. Performance impairment from Z-‐drugs – Invited speaker
35. Gunja N. ACEM Annual Scientific Meeting, Adelaide 2013. SIMWARS Facilitator, Toxicology workshop instructor
36. Dutch North Sea Emergency Medicine Conference, Amsterdam NL 2013. Antidote Update – Invited speaker, Toxic cardiac arrest – workshop instructor
37. Gunja N. ACMT Scientific Meeting, San Juan, Puerto Rico 2013: Sedation of the agitated patient – Invited speaker, Physostigmine in psychotropic anti-‐cholinergic poisoning – Poster
38. Gunja N. AAFS (Australian Academy of Forensic Sciences), Sydney 2013: The Art of Poisoning – Keynote Speaker
39. Gunja N. Paediatric GP Update, CHW Sydney. Lead poisoning – invited speaker
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Committees & Boards Staff at the NSW Poisons Information Centre provided expertise to the following local, regional, national and international committees and boards: Jared Brown
• TGA Medicine Labelling and Packaging Review Group Prof Nicholas Buckley
• Chair of the Editorial Advisory Board of the Australian Medicines Handbook. • Member of the Australian Advisory Committee on the Safety of Medicines (ACSOM). • Member of Editorial boards: Australian Therapeutic Guidelines -‐ Toxicology and
Wilderness, TOXINZ & Hypertox (electronic databases of poisoning information), the journals Drug Safety (0114-‐5916), Clinical Toxicology (0009-‐9309), and Australian Prescriber
• President-‐elect of the Asia Pacific Association of Medical Toxicology.
Prof Andrew Dawson
• Advisory Committee on Medicines Scheduling (acting Chair) • Advisory Committee on Chemicals Scheduling(acting Chair) • Board Member Australasian Society of Clinical and Experimental Pharmacologists
and Toxicologists • Editorial Board Ceylon Medical Journal • Editorial Board Journal of the Ceylon College of Physicians • Senior Editorial Board Journal of Clinical Toxicology • Editorial Board Journal of Indian Society of Toxicology • Senior Editorial Board WikiTox • Director South Asian Clinical Toxicology Collaboration
Dr Naren Gunja
• ACEM Primary Examination Committee – Chair of Pharmacology • ACMT International Committee – Regional ambassador • ACMT Public Affairs Committee – Member
Awards Prof Andrew Dawson
• NHMRC Practitioner Fellowship • 2013 American College of Medical Toxicology Service Award for Outstanding
Contribution in Medical Toxicology Education. Awarded at ACMT Annual Scientific Meeting, Puerto Rico March 17 2013
• 2013 Asia Pacific Association of Medical Toxicology, Honorary Fellow
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Toxicovigilance activities Research and audit are key to the public health focus of the NSW Poisons Information Centre. Over 2013, NSWPIC has provided data as follows:
• Panadol faulty syringe recall cases • Laundry product exposures to ACCC, with an emphasis on laundry pods • Prescription drug abuse data (prescription opioids and stimulants) to Global
Toxicology Network collaboration • Call data pertaining to accidental carbon monoxide exposures from burning charcoal
products was provided to the Australian Competition and Consumer Commission (ACCC).
• Call data pertaining to paediatric laundry detergent pod exposures was provided as part of an ongoing national PIC study.
• Therapeutic error call data was provided to QLD PIC, for presentation at the Society of Hospital Pharmacists of Australia NationalMedicines Management Conference.
• Call data pertaining to Lye water exposures was provided to South Australia’s Public Health division.
• Mushroom exposures was provided to the Australia-‐wide study ‘Poisoning due to fungi ingestion – a retrospective study of cases reported to Australian Poisons Information Centres’.
• Provision of data and recruitment commenced through NSWPIC for Australian Toxicology Monitoring (ATOM) studies on paracetamol and digoxin
• Analysis of National Coronial Information System for deaths from pesticides • Australian Government Department of Health was provided with data on exposures
to OxyElite • Australian Red Cross Blood Service was provided with data on iron ingestions • Collaboration with Honours student at the Faculty of Pharmacy, The University of
Sydney on drug related problems from over the counter medicines in young children • Provision to the Therapeutic Goods Administration on dosing errors with
paracetamol and ibuprofen • Intravenous paracetamol dosing errors provided to NSW Therapeutic Advisory
Group • Data on synthetic cannabinoid exposures and illicit drug exposures supplied to NSW
Health • Laundry pod exposures to Unilever • E-‐cigarette exposures to NSW Health • Mushroom exposures to SA Health • Calls relating to mercury from South Eastern Sydney Local Health District, Public
Health Unit • Call data pertaining to infant colic mixtures prepared by compounding pharmacies
was provided to the Pharmacy Board of Australia, care of VICPIC
Clinical governance and quality assurance activities All poisons information specialist calls were peer-reviewed by another poisons information specialist. Cases which clinical toxicologists are consulted on are circulated to all NSWPIC clinical toxicologists and poisons information specialists for review.
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Calls received per month for 2013 and 2012
Month 2013 2012 January 9118 9823 February 8655 9009 March 9238 9511 April 8154 8400 May 8254 8893 June 8057 8419 July 8351 8384 August 8729 8969 September 8710 8934 October 8928 9153 November 8597 9578 December 8914 9619
Victims of poisoning
Adults: 46250 Children: 44964 Animals: 2066
50%
48%
2%
Adults
Children
Animals
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Call Characteristics Calls by Geographic Source Calls are received from all over the country at the New South Wales Poisons Information Centre. A breakdown of these calls appears below. The calls taken from interstate (other than Tasmania and the Australian Capital Territory) are done so during after-hours night shifts.
State Number of calls % of calls New South Wales 68615 66.2 Queensland 9354 9.0 Victoria 7896 7.6 Unknown 5425 5.2 Tasmania 3285 3.2 Australian Capital Territory 3077 3.0 South Australia 2936 2.8 Western Australia 2733 2.6 Northern Territory 288 0.3 International 96 0.1 TOTAL 103705
In addition to calls taken by NSW PIC, the other three PICs handled the following call volumes:
State Number of calls Victoria 38740 Western Australia 38261 Queensland 30734
Route of Exposure
Calls involving route Number of calls % of calls Ingestion 62944 80.5 Ocular 4722 6.0 Dermal 3576 4.6 Inhalation/Nasal 3095 4.0 Bite/Sting 3034 3.9 Parenteral (eg injected) 645 0.8 Unknown/Other 215 0.3
NB: Multiple routes of exposure are possible
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Persons calling the Poisons Information Centre
Caller background Number of calls % of calls Family 44186 43.6 Self 21609 21.3 Doctor 12068 11.9 Nurse 6578 6.5 Unknown 5315 5.2 Carer 2533 2.5 Ambulance 2487 2.5 Group Home 2083 2.1 Friend 2006 2.0 Other 1259 1.2 Pharmacist 482 0.5 Counselling service 364 0.4 Vet 325 0.3 Other medical 100 0.1
Hourly call breakdown
Time Number of calls % of calls Midnight – 0100 2081 2.0 0100 – 0200 1733 1.7 0200 – 0300 1352 1.3 0300 – 0400 1125 1.1 0400 – 0500 818 0.8 0500 – 0600 815 0.8 0600 – 0700 1992 1.9 0700 – 0800 4839 4.7 0800 – 0900 5924 5.7 0900 – 1000 6268 6.0 1000 – 1100 5467 5.3 1100 – 1200 4460 4.3 1200 – 1300 4146 4.0 1300 – 1400 4087 3.9 1400 – 1500 4465 4.3 1500 – 1600 4333 4.2 1600 – 1700 5293 5.1 1700 – 1800 5752 5.5 1800 – 1900 6055 5.8 1900 – 2000 6247 6.0 2000 – 2100 6423 6.2 2100 – 2200 7414 7.1 2200 – 2300 7450 7.2 2300 -‐ MIdnight 5162 5.0
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Histogram based on time of calls
NB: There are 7 shifts per fortnight Midnight – 0600 which are handled by interstate PICs
Handling of Calls – Adult
Handling Number of calls % of calls At GP surgery 486 1.2 Referred to GP 1101 2.6 Referred to Hospital 5442 13.0 In Hospital 10531 25.2 Other 1405 3.4 Stay at home 15554 37.2 Unknown 10 0.0
0 1000 2000 3000 4000 5000 6000 7000 8000
Midnight –
0100
0100 – 0200
0200 – 0300
0300 – 0400
0400 – 0500
0500 – 0600
0600 – 0700
0700 – 0800
0800 – 0900
0900 – 1000
1000 – 1100
1100 – 1200
1200 – 1300
1300 – 1400
1400 – 1500
1500 – 1600
1600 – 1700
1700 – 1800
1800 – 1900
1900 – 2000
2000 – 2100
2100 – 2200
2200 – 2300
2300 -‐ MIdnight
1% 3%
16%
31%
4%
45%
0% At GP surgery
Referred to GP
Referred to Hospital
In Hospital
Other
Stay at home
Unknown
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Handling of Calls – Child (<18 years)
Handling Number of calls % of calls At GP surgery 350 0.8 Referred to GP 324 0.8 Referred to Hospital 2496 6.0 In Hospital 5124 12.2 Other 936 2.2 Stay at home 32628 77.9 Unknown 8 0.0
1% 1%
6%
12% 2%
78%
0% At GP surgery
Referred to GP
Referred to Hospital
In Hospital
Other
Stay at home
Unknown
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Age in Years of Children
Age Number of calls % calls <1 4282 10.8 1 10747 26.3 2 9616 23.6 3 4628 11.3 4 2281 5.6 5 1342 3.3 6 884 2.2 7 681 1.7 8 552 1.4 9 377 0.9 10 415 1.0 11 337 0.8 12 397 1.0 13 538 1.3 14 844 2.1 15 1054 2.6 16 917 2.2 17 791 1.9
Calls based on Gender
Gender Number of calls % of calls Female 46144 53.4 Male 39256 45.4 Unknown 1042 1.2
0
2000
4000
6000
8000
10000
12000
<1 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17
Num
ber o
f calls
Age in years
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Call type
Call Type Number of calls % of calls Exposure 72964 70.4 Query 20031 19.3 Re-‐call 5052 4.9 Unknown 5658 5.5
Types of exposure
Exposure Type Number of calls % calls Accidental 48269 60.9 Adverse reaction 1033 1.3 Deliberate self-‐poisoning 12354 15.6 Environmental 60 0.1 Food Poisoning 83 0.1 Intentional: other 1410 1.8 Occupational 143 0.2 Other 62 0.1 Other/Unknown 197 0.2 Pregnancy 51 0.1 Recreational 994 1.3 Therapeutic error 13542 17.1 Unknown 229 0.3 Work place 813 1.0
Types of queries
Query Type Number of calls % calls Breastfeeding 567 2.1 Drug Information 10573 39.2 Environmental 124 0.5 Inappropriate call-‐referred 885 3.3 Medical 930 3.4 Occupational 35 0.1 Poisons info 7421 27.5 Pregnancy 556 2.1 Prevention/safety 643 2.4 Wrong number/hoax call/phone line issue
5246 19.4
18
Calls referred from health phone triage services
Phone triage referral sources
Number of calls % of calls
Healthdirect Australia (all states and territories except Victoria and Queensland)
2783 2.7
Nurse on Call (VIC) 969 0.9 13HEALTH (QLD) 647 0.6 MiHealth 153 0.1 GP Assist 90 0.1
Substances which generate the most calls The following table shows the Top 10 substances that generated the most calls to the New South Wales Poisons Information Centre in 2013. The full list of exposures by substance in adults and children is available on request. Substance Number of calls*
Paracetamol-‐containing product 7243
Ibuprofen-‐containing product (systemic) 2567
Ethanol 1716
Quetiapine 1594
Paracetamol + narcotic combination analgesic 1381
Diazepam 1317
Spiders 1249
Bleach (hypochlorite-‐based) 1165
Desiccant (silica gel) 1037
Cleaners (all-‐purpose/hard-‐surface) 1003
*Number of unique calls reported, ie calls which generated call-backs (re-calls) are excluded
Summary of calls referred to medical consultants NSWPIC referred 1715 calls to a medical toxicologist. Many calls involve multiple substances. The full list of substances involved in calls to medical toxicologists is available on request.
