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Food Recalls and America's Poison CentersAmerica’s Poison Centers play a key role in keeping the public safe in the event of food recalls. The Centers for Disease Control and Prevention (CDC) estimates 76 million people suffer from food-borne illnesses each year in the United States, accounting for 325,000 hospitalizations and more than 5,000 deaths. Poison Centers serve as a primary source of information when the public needs to know which food products are being recalled. More importantly, they can identify the symptoms of a food-borne illness and help manage the appropriate treatment regimen. Generally, food recalls result from three main causes:
Poison Centers receive regular notices identifying which food products are being recalled. The American Association of Poison Control Centers (AAPCC) also provides member centers with a weekly update that lists all recalled products. The recent recalls involving salmonella-tainted products made by the Peanut Corporation of America provide a good example of how Poison Centers function. Poison Centers always experience a sharp increase in calls from the public during such incidents. The Poison Centers keep track of the lot number and production date of recalled products to help identify whether they should be discarded, or to help pinpoint the source of a caller’s illness. Poison Centers are staffed by nurses, pharmacists, and physicians who specialize in toxin-related illnesses. Staff can quickly identify the cause of an adverse reaction to a food product and provide guidance to callers, as well as fellow health care professionals, on the best way to treat it. Poison Centers are open 24 hours a day, 7 days a week, making them the one source the public can always reach with questions about recalled food products. Patient Safety and Clinical Pharmacy Services Collaborative Hosts Second Learning SessionThe Patient Safety and Clinical Pharmacy Services Collaborative (PSPC) hosted its second Learning Session (LS2) December 3-4, 2008 at the Gaylord National Hotel in National Harbor, MD. Sponsored by HRSA’s Healthcare System Bureau, Office of Pharmacy Affairs and HRSA’s Center for Quality, the Collaborative is designed to improve the quality of care for patients by improving patient safety and patient health outcomes through the integration of clinical pharmacy services into primary care. The PSPC consists of 68 teams from around the country engaged in rapid improvements by learning, replicating, testing, and adopting specific leading practices already found to be effective in high performing organizations. The highlight of LS2 were the presentations of 25 teams who shared their early challenges and successes in integrating their health care systems with clinical pharmacy services and documenting their improved health outcomes. Mark Ryan, PharmD, Director of the Louisiana Poison Control Center (LPCC), was among the team members who presented at LS2. Dr. Ryan and his fellow team members from the David Raines Community Health Center presented their plan to eliminate polypharmacy and raise awareness of the potential for accidental drug overdose due to polypharmacy or other reasons. To that end, the team showcased their pharmaceutical reconciliation patient form designed to eliminate duplicate therapies, monitor for potential drug interactions, and facilitate tailored patient counseling. Dr. Ryan’s team also discussed efforts to educate patients about the services provided by the LPCC to encourage utilization of the Poison Help Line for medication questions when the clinic is not available. “Attending the Learning Sessions has provided us with a wealth of new ideas and information that we can use to build on and expand our efforts. We have also been very fortunate to make many new contacts at the sessions,” said Dr. Ryan of his participation in LS2. Other Poison Center directors participating in the Collaborative include Dr. Jess Benson from the New Mexico Poison and Drug Information Center, Dr. Doug Borys from the Central Texas Poison Center, Michele Caliva from the Upstate New York Poison Center, Dr. Barbara Crouch from the Utah Poison Control Center, and Dr. Marsha Ford from the Carolinas Poison Center. The PSPC will meet again at Learning Session 3 at the Grand Hyatt in Washington, D.C. on May 6-7, 2009. More information on how to join PSPC. Poison Center Experts Collaborate with Hollywood, Health, & SocietyAs reported last year, the HRSA Poison Control Program (PCP) has partnered with the Centers for Disease Control and Prevention to collaborate on a project with Hollywood, Health, & Society (HH&S). HH&S is a project at the USC Annenberg Norman Lear Center that provides screenwriters and producers with accurate and timely information for health storylines. According to a 2005 Porter Novelli Health Styles survey, over half of regular primetime drama/comedy viewers reported that they learned something about a disease or how to prevent it from a TV show. About one-third of regular viewers said they took some action after hearing about a health issue or disease on a TV show. Through our partnership with HH&S, the PCP aims to raise public knowledge about poison prevention, the critical role of Poison Center services, the toll-free number and the need for more support for Poison Centers at the State and local levels. To that end, the following Poison Center personnel have accepted invitations to serve as poison experts for HH&S consultations.
The PCP trusts that HH&S will come to rely on these poison experts in the same way that HH&S relies on HRSA’s Healthcare Systems Bureau, Division of Transplantation (DoT) for accurate information about organ and blood stem cell donation and transplantation. Over the past 3 years, DoT experts have helped shape accurate storylines featured in Grey’s Anatomy, Numbers, General Hospital, and other television programs.
For more information please visit The Norman Lear Center Web site. Poison Center Educators Gather in Richmond, VirginiaSince 2007, HRSA’s Poison Control Program (PCP) has supported several regional meetings for Poison Center health educators with assistance from the Poison Center Technical Assistance Resource Center (PC TARC). The purpose of these meetings is to provide educators with a format and agenda conducive to their professional development, programmatic needs, and the broader objectives of the programs they represent. At these meetings, HRSA brings together educators from similar geographic areas in an effort to network, share best practices, and identify resources to bolster their respective poison education programs. The Mid-Atlantic Educator’s Regional Meeting was convened on February 5, 2009 at the Virginia Poison Center (VPC) and featured presentations on Media Matters, Outcome Measurement, and Survey Design. In addition, a focus group session was facilitated by Edelman, the public relations firm that is under contract to assist the PCP with implementation of the Poison Help Campaign. The focus group was designed to elicit feedback about the future direction of the Campaign. Educators also participated in a unique Question & Answer session that was moderated by HRSA PCP Director, Lori Roche.
Mid-Atlantic Educators’ Regional Meeting. Names listed from left to right: Top: Nicholas S., Sue K., Lori R., Donna L., Deborah H-J, Joni B., Paul J., Angel B. Middle: Denise N., Evelyn W. Bottom: Holly W., Gloria J-M, Kristen W., Alexa S., Kimberly C. To date, 72 US PCC educators have participated in five regional meetings. For more information, please contact PC TARC at: PCTARC@pire.org . Poison Workgroup Plans Several Initiatives to Decrease the Prescription Pain Pill FatalitiesDeaths from poisoning have increased dramatically in the United States. In 2005, nearly 26,700 Americans died from an unintended or undetermined-intent poisoning, a nearly four-fold increase over the 6,921 who died in 1990. Prescription pain medications, such as methadone, oxycodone, hydrocodone, morphine, and fentanyl are largely responsible for this alarming increase in drug poisoning death rates. The Poison Workgroup (PWg) - a group of professionals interested in poison prevention - is working to reverse this alarming trend and increase awareness about the dangers of prescription drug and opioid narcotic misuse and abuse. Formed in 2006 at the State and Territorial Injury Directors Association (STIPDA) Meeting, the PWg includes epidemiologists, toxicologists, prevention specialists, State-based injury experts, poison educators, academics, government officials, and survivors of opioid narcotic abuse. The Health Resources and Services Administration (HRSA) Poison Control Program (PCP) supports the group's conference calls and in-person meetings. Members of the PWg are working on several prescription pain pill initiatives targeted at consumers, prescribers or policy makers.
Subcommittees exist for each of the above initiatives and the PWg is open to anyone interested in joining. Any and all documents produced by these efforts will be freely shared with any interested party. If you would like to work with the PWg or would like more information, please send an e-mail to sheppard@pire.org. back to topKentucky Regional Poison Center Provides Critical Services During the State’s Worst Ice StormOn January 27, 2009 a winter ice storm knocked out power to more than 850,000 people including 600,000 people in Kentucky as subfreezing temperatures dropped into the single digits. Unaccustomed to such severe winter temperatures, thousands of Kentucky residents turned to alternative sources of heat and power, such as gasoline powered generators, kerosene heaters and propane gas stoves in attempts to stay warm. During the weeks that followed the storm and clean-up, the Kentucky Regional Poison Center (KRPC) experienced a significant spike in calls about carbon monoxide and kerosene poisoning exposures—a 400 percent to 800 percent increase over previous years (see Figure 1 for carbon monoxide exposures). Although half of the KRPC staff lost power in their own homes, the KRPC continued its normal operations and successfully managed these poisoning exposures in addition to managing a 20 percent call increase (as compared to the previous year) in all poisoning exposures. The KRPC also worked closely with the Kentucky Department of Public Health (DPH) as the DPH tracked the effects of the storm and directed emergency response efforts. The DPH relied on KRPC data as it was the only source that could be tracked to the city/town and county levels in real-time. Other sources of data (e.g., hospital admission data, coroner’s data, and emergency department data) were completely unavailable for some of the worst hit counties or, at best, several days behind. The collaboration between KRPC and DPH strengthened an already positive relationship and helped save lives in the Kentucky region. Figure 1 Bar Graph illustrating the number of Carbon Monoxide Exposures
National Poison Prevention Week 2009: March 15-21, 2009National Poison Prevention Week 2009 was commemorated across the country as communities partnered with local Poison Centers to raise awareness about poison prevention. In the Nation’s Capital, the week was kicked off with a press event at the National Press Club sponsored by the National Poison Prevention Week Council. Featured speakers included Mary Wakefield, Ph.D., R.N., the newly named Administrator of the Health Resources and Services Administration (HRSA). Appointed by President Barack Obama on February 20, 2009, she resigned as Dean of Rural Health at the University of North Dakota School of Medicine and Health Sciences to begin her post at HRSA on March 10. At the press event, Dr. Wakefield highlighted why the Poison Help toll-free number, 1-800-222-1222, is such an important resource, stressing the barriers that underserved and hard-to-reach populations face, especially in remote areas. “Every year at this time, we are reminded that poisonings are preventable. But ultimately, each and every one of us needs to be prepared for prevention,” she said. Dr. Wakefield also announced the release of HRSA’s new publication, Safe Medicine Use & Poison Prevention Tips: A Guide for Older Adults and Caregivers, that was developed with guidance from several poison control center experts. Other speakers at the press event included:
For more information about National Poison Prevention Week and the National Poison Prevention Week Council, visit the POISONPREVENTION.ORG Web Site. HRSA-Funded "Taking Your Medicine Safely" Wins Award at the 2009 Joint Annual Meeting of State and Territorial Injury Prevention Directors Association & CDC Core State Injury Grantees“Taking Your Medicines Safely: A Community Senior Center Education Program” is the winner of the “Innovative Initiative of the Year” Award from the State and Territorial Injury Prevention Directors Association (STIPDA). The STIPDA award was announced at the 2009 Joint Annual Meeting of STIPDA & CDC Core State Injury Grantees in National Harbor, Maryland on February 25, 2009. Selected exclusively by members of STIPDA, the “Innovative Initiative of the Year” Award is presented to a STIPDA member who has implemented a unique and creative program or activity that has the potential to substantially decrease injuries and violence in the communities they serve. Funded by HRSA’s Poison Control Program, “Taking Your Medicines Safely” was developed and evaluated by the Pacific Institute for Research and Evaluation (PIRE). This innovative project was designed to prevent unintentional drug misuse and/or interaction poisonings among seniors and to promote Poison Centers as a resource for medication safety questions. The program was conducted by health educators or senior center personnel and provides seniors with a presentation covering six core concepts: (1) dangers associated with combining prescription and over-the-counter medications with vitamins, supplements, or herbal remedies; (2) patient-provider communications about medicines; (3) medicine information resources; (4) locating and organizing medications; (5) medication management techniques; and (6) Poison Center information. Attendees of the STIPDA meeting had an opportunity to hear firsthand about the program at the “Preventing Unintentional Poisonings” session where Monique Sheppard, Ph.D., PIRE, provided an overview of the “Taking Your Medicines Safely” program. Other panelists included Dr. Len Paulozzi from CDC’s National Center for Injury Prevention and Control, who presented on what States are doing to address the non-medical use of prescriptions, and Scott Proescholdbell from the North Carolina Division of Public Health, who discussed the feasibility of unintentional poisoning death reviews in North Carolina. Look for a downloadable version of the “Taking Your Medicines Safely” program later this year on the PoisonHelp Web site. Poison Help Campaign UpdateThe Poison Help campaign has evolved in recent months with the award of the national media campaign to a new contractor in October 2008. Since the contract award, the Poison Control Program has explored potential growth opportunities by connecting directly with Poison Centers through a variety of sources. Feedback has been received through a questionnaire of Poison Center needs, a focus group of Mid-Atlantic center educators in Richmond, VA, and a presentation and discussion at the AAPCC Mid-year meeting in Albuquerque, NM. These meetings and continued feedback from Poison Centers will help determine the campaign's direction for 2009 and beyond. The overarching objective for the Poison Help campaign are to:
With these objectives in mind, feedback gathered in recent months will be reviewed to develop and solidify specific tactics for the campaign. Upcoming changes include modifying and simplifying the existing national campaign Web site, developing an online promotion strategy for the site, launching a companion Spanish language Web site, and engaging online with key influencers to broaden the campaign's media reach. The Nation’s Poison Centers and the Poison Help number (1-800-222-1222) continue to be important resources for consumers and emergency responders as indicated by the continued increases in call volume on the national help-line (see chart below). However, more can be done to highlight the role each plays in preventing and responding to poison incidents. With support from the AAPCC and guidance from Poison Centers, the campaign will continue to look for ways to enhance the general public’s awareness and showcase the work of the Nation’s Poison Centers. 1-800-222-1222 Toll-Free Number Usage Continues to IncreaseThe HRSA Poison Control Program manages a national 1-800 number that connects callers directly to a nurse, pharmacist, and other poison expert at their local Poison Center free of charge. Poison Centers handle calls 24 hours per day, 7 days per week. Since 2003, the number of calls that are routed to Poison Centers through the 1-800 number, as a percentage of all calls to Poison Centers, has been steadily increasing. See graphic below.
CDC Sponsors Two Meetings with a Focus on the Prescription Pain Pill EpidemicThe Centers for Disease Control and Prevention (CDC) sponsored a series of two meetings at its headquarters in Atlanta this winter to examine the epidemic of prescription pain pill abuse and misuse fatalities. Participants from Federal agencies, law enforcement, injury prevention and State and local governments came together to learn more about the public health implications and promising responses to this public health crisis The first meeting, Promising Legal Responses to the Epidemic of Prescription Drug Overdoses in the United States, was held on December 2-3, 2008. Participants were provided with a broad overview of the epidemiology of fatal drug overdoses to set the stage for discussing the legal responses used by various States, communities and jurisdictions. These responses included prescription drug monitoring programs, doctor shopping statutes, State-issued prescription forms, pain clinic legislation and the role of drug courts. The follow-up meeting, State Strategies for Preventing Prescription Drug Overdoses, was held on January 13-14, 2009. The meeting focused on promising strategies that States are using to curb the rapid increase in deaths due to prescription pain pills. Discussion revisited the use of prescription drug monitoring programs and also focused on the role of medical examiner data and the broader utility of epidemiologic surveillance to monitor trends. Other topics included the use of insurance claims to reduce transferal fontanel pharmacy use; the implementation of opioid guidelines for chronic non-cancer pain patients; and the use of naloxone—a non-addictive prescription medication that serves as an antidote to reverse respiratory depression caused by opioid poisoning. Evaluation of Adverse Drug Reactions Reported to a Poison Control Center Between 2000 and 2007An evaluation of adverse drug reactions reported to the New Jersey Poison Information and Education System (NJPIES) was published in the March 1, 2009 edition of the American Journal of Health-System Pharmacy. The purpose of the study was to determine the likelihood of hospitalizations caused by adverse drug reactions. The evaluation revealed substantial variation in the probability of hospitalization resulting from adverse drug reactions (ADRs). The drugs most commonly implicated in those hospitalizations reported as having ADRs (in over 5 percent of all ADRs) were antidepressants, followed by dietary supplements, herbals, homeopathics, sedatives, hypnotics and anti-psychotics. By looking only at those classes of drugs that were frequently reported to NJPIES (over 4.7 percent of all calls for ADRs), the proportion of these ADRs which resulted in hospitalizations was by far greatest among those exposed to antidepressants. The study also revealed that those patients who have ADRs after exposure ao anticoagulants (58 percent) were more likely to be hospitalized than if the ADR was after exposure to, for example, stimulant, street drugs (9.4 percent). The latter substances, however, did not represent high percentages of all reported ADRs even though they are intuitively more likely to require hospitalization. This finding points to a need for further research. Steven M. Marcus, M.D., Bruce Ruck, Pharm.D., and Alvin F. Chu, Ed.D., M.P.H., of the NJPIES were three of the five authors who collaborated on this study. To access the full article, visit the American Journal of Health-System Pharmacy web site. NCSL Highlights Poisoning and Poison Centers for State LegislaturesWorking in collaboration with the Poison Control Program, the National Conference of State Legislatures (NCSL) has distributed an informational postcard on poisonings and poison control centers to over 2,400 State legislators on health committees and legislative staff interested in health issues. A Web version of the postcard is also available on the NCSL Web site. Call for Newsletter SubmissionsAre you conducting interesting research on poisoning? Would you like others to know about your poison prevention initiative? Are you engaged in a unique collaboration to educate others about the dangers of poisoning? Send suggestions or articles for consideration in the next edition of the Poison Control Program Newsletter to Rebeca Sanchez-Barrett at 301-443-0324 or rsanchez-barrett@hrsa.gov.
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