ANNUAL REPORT. Saving lives, saving dollars is a simple way of stating what the Maryland Poison Center does every day.

Transcription

1 2010 ANNUAL REPORT This report provides an overview of the Maryland Poison Center experience during FROM THE DIRECTOR Greetings! Welcome the Maryland Poison Center 2010 Annual Report. This annual report represents the end of another decade of service for the Maryland Poison Center (MPC). It s interesting and instructive look back at where you ve been figure out where you are and how far you ve come. It is especially intriguing review and compare what s happening now with the past when the year Bruce Anderson ends in a zero. So, I thought it would be worthwhile compare the MPC s experiences in The year 2000 seems so quaint now, yet at the time it seemed sort of magical! People were worried that the computers we relied on would fail. The dot-com bubble was starting burst, the U.S. presidential election introduced a new phrase in popular language ( hanging chad ), and people were getting concerned about rising gas prices (average cost in the U.S. was up $ 1.70!). Things clearly have changed. Change can be seen in the data from the MPC in 2000 and % change Total call volume 57,306 62, Human exposures 35,270 35, Drug ID calls 5,527 17, While human exposure call volume has remained about the same, there has been a dramatic increase in drug identification calls managed by the MPC. This increase in drug ID requests mirrors the increase in misuse and abuse of prescription medications in the United States. The problem of prescription drug abuse is staggering. According the Centers for Disease Control and Prevention, there were 2,901 unintentional drug deaths involving opioid analgesics in 1999 compared 11,499 in Additionally, there were nearly twice as many deaths in 2007 involving opioid analgesics than deaths involving cocaine, and more than five times as many as those involving heroin. And the problem is growing. Prescription medications are now the fourth most abused substances (behind bacco, alcohol, and marijuana). The MPC can help provide information on specific substances identified and from where those calls are coming. This information can be used in targeting substance abuse awareness and prevention efforts. Our staff of pharmacists and nurses have more than 160 years combined experience managing poisoning and overdose cases and continually update their training keep up with changes in the types of calls that come in the MPC. In addition, our geographic information specialist and statistician enable us analyze our data for research purposes and provide data other partners throughout the state. Our educars reach out health professionals and the public keep them informed of changing trends and of the services we offer. The makeup of the types of calls may change over time, but the mission of the MPC stays the same: we save lives and save dollars by providing emergency triage and treatment information for all callers. Bruce Anderson, PharmD, DABAT Direcr of Operations, Maryland Poison Center Associate Professor, Department of Pharmacy Practice and Science University of Maryland School of Pharmacy Saving lives, saving dollars is a simple way of stating what the Maryland Poison Center does every day. The mission of the Maryland Poison Center is decrease the cost and complexity of poisoning and overdose care while maintaining and/or improving patient outcomes. We are continuing work ward this mission by conducting research on the management of poisoning and overdose patients, through public education try prevent poisonings from occurring, by training health professionals (pharmacists, nurses, physicians, and paramedics) in the management of poisoning and overdose care, and by working with the public health infrastructure in Maryland help recognize poisoning challenges and working respond those challenges

2 In 2010, the Maryland Poison Center received 62,820 calls. While 35,895 of these calls (some from out of state) involved a human exposure, the remaining 26,925 were requests for information or involved animal poisonings. AGE 48.1 percent of poison exposures involved children under the age of 6 as shown in the diagram below. The data for counties is as accurate as possible given that some zip codes cross county boundaries. *Numbers for Montgomery and Prince George s counties reflect calls the MPC only. The number aumatically connects callers from these counties the National Capital Poison Center in Washingn, D.C. Some callers reach the MPC by dialing local telephone numbers still in service. Callers from unknown Maryland counties and from other states accounted for 5.3 percent of the human exposures in years 29.9% years 7.0% >60 years 7.3% 6-12 years 6.3% Unknown age 1.3% GENDER 47.5 percent of exposures occurred in males, and 52.3 percent in females (0.2 percent unknown). <6 years 48.1% SITE OF CALLER Most of the calls the MPC came from the patient s residence or another residence (71.2 percent). Some 19.8 percent of the callers were health care providers (hospital, docr s office, clinic, and others). In 4.5 percent of the cases, an emergency medical services provider (EMS, paramedics, first responders, emergency medical dispatcher) called the MPC for treatment information. Calls originating from teachers, students, and nurses in schools accounted for 1.8 percent of the calls in EMS Provider 4.5% Health care facility 19.8% Other/Unknown 2% Workplace 0.7% School/ School nurse 1.8% ANIMAL EXPOSURES In 2010, a tal of 1,981 potentially xic exposures in animals were reported. Residence 71.2% Our mission is decrease the cost and complexity of care while maintaining and/or improving patient outcomes. These data clearly show that we re meeting our mission. 2 2

3 Managed in HCF 26.4% Other/Unknown 1.3% Refused referral 1.2% Managed on-site/ non-hcf 71.1% CIRCUMSTANCE The people who contact the MPC do it for several reasons: Unintentional exposures in children and adults, occupational or environmental exposures, bites/stings, therapeutic errors, misuse of products, and food poisoning accounted for 76.5 percent of tal exposures. Therapeutic errors (doubledoses, wrong medicines taken, etc.) alone accounted for 13.1 percent of tal exposures. Intentional exposures, due misuse, abuse or suicide attempts, accounted for 18.5 percent of tal exposures. Adverse reaction drugs, food, and other substances accounted for 3.6 percent of tal exposures. Other/unknown reasons, including malicious or contaminant/ tampering, accounted for 1.5 percent of tal exposures. MPC SAFELY MANAGES PATIENTS AT HOME In 2010, 71.1 percent of all poisoning cases were safely managed at home (site of exposure), which saves millions of dollars in unnecessary health care costs compared with managing patients in a health care facility (HCF). It also allows more efficient and effective use of limited health care resources. Calling the MPC helps save lives and save dollars! Intentional 18.5% Adverse reaction 3.6% Other/Unknown 1.5% Unintentional 76.5% Moderate effect 5.5% Major effect 0.6% Death 0.1% Other/Unknown 4.2% No effect 31.3% OUTCOMES The true measure of the effectiveness of the MPC program is in patient outcomes. Although there were 35 cases reported MPC that resulted in death (0.1 percent) in 2010, the impact of the MPC is obvious: few cases had poor outcomes. Some 89.7 percent of cases resulted in (or were expected result in) no effects or minor effects. For all exposures, prompt attention is the best way reduce the likelihood of developing severe xicity. Minor effect 58.4% ROUTE OF EXPOSURE The most common way that patients in Maryland were exposed xins was by ingestion. This includes cases of children putting substances in their mouths, patients mistakenly ingesting someone else s medicine, people accidentally brushing their teeth with a product intended for pical use, etc. The dermal route was the next most common means of exposure. Some cases involved multiple routes of exposure. *Percentages in the chart are based on the tal number of human exposures. Dermal 9.3% Ocular 4.9% Inhalation 4.6% Bite/Sting 1.2% Other 1.5% Ingestion 85.0% 3 3

4 SUBSTANCES INVOLVED IN POISONINGS The tables below list the most common substances involved in poisonings and overdoses reported the MPC in Some 71.8 percent of the poisoning and overdose calls the MPC involved a drug, while 50.0 percent of calls involved a non-drug substance. A patient may be exposed more than one substance in a poisoning or overdose case. *Percentages in the tables are based on the tal number of human exposures. DRUG SUBSTANCES # % Analgesics 5, % Sedatives/Hypnotics/Antipsychotics 3, % Antidepressants 1, % Cardiovascular Drugs 1, % Antihistamines 1, % Topical Preparations 1, % Cold and Cough Preparations 1, % Antimicrobials 1, % Vitamins % Hormones & Homone Antagonists % Others 5, % TOTAL 25, % NON-DRUG SUBSTANCES # % Cosmetics/Personal Care Products 3, % Cleaning Substances (Household) 2, % Foreign Bodies/Toys/Miscellaneous 1, % Alcohols 1, % Pesticides 1, % Food Products/Food Poisoning % Plants % Arts/Crafts/Office Supplies % Bites and Envenomations % Hydrocarbons % Others 3, % TOTAL 17, % TOTAL HUMAN EXPOSURES 35,895 TOTAL HUMAN EXPOSURES 35,895 TREATMENT The tables below list antidotal therapies and decontamination treatments used for poisonings in Maryland during Most patients were managed conservatively with dilution (given something drink), irrigation or washing. ANTIDOTAL THERAPIES # Naloxone 607 IV acetylcysteine 209 Alkalinization 162 Oral acetylcysteine 131 Calcium 46 Atropine 36 Fomepizole 43 Glucagon 38 Insulin 37 Other Antidotes 106 TOTAL 1,415 DECONTAMINATION TECHNIQUES # Dilute/Irrigate/Wash 20,031 Single-Dose Activated Charcoal 2,081 Food/Snack 1,779 Fresh Air 961 Other Emetic 244 Lavage 50 Cathartic 5 1 Whole Bowel Irrigation 28 Multi-Dose Activated Charcoal 36 Ipecac 8 TOTAL 25,

5 Outreach, education, and research are key elements of the MPC s services. In 2010, the MPC led 127 education programs and events for public and health professional groups, attended by more than 10,100 people. Educational materials were distributed throughout Maryland at programs, health fairs, and by community organizations. PUBLIC AND PROFESSIONAL EDUCATION 2010 The MPC is well known for being an emergency telephone service that helps those who have been poisoned, including unintentional poisonings in small children, exposures household products, occupational exposures, and intentional overdoses. But did you know that the MPC also educates thousands of people each year about poisonings and overdoses? Our public education efforts are intended help increase the awareness of the poisons that are found in every home, business, and school, and help prevent poisonings from occurring. The MPC also strives make sure that everyone knows that they can quickly and easily get information by contacting the MPC, 24/7, if a poisoning occurs. In 2010, the MPC provided speakers and/or materials for 103 programs in 18 Maryland counties, Baltimore City, and Washingn, D.C. The programs and events staffed by the MPC were attended by more than 5,800 people. Several organizations partnered with the MPC provide education their patients, cusmers, clients, and students. These organizations included fire departments, police departments, hospitals, health departments, schools, child care agencies, pharmacies, hospital perinatal education programs, CPR instrucrs, parish nurses, Red Cross, and Head Start and Healthy Start programs. In all, more than 58,000 pieces of educational materials (brochures, magnets, telephone stickers, Mr. Yuk stickers, teacher s kits, and other pieces) were distributed at these programs and by these organizations. Approximately 135,000 additional materials were mailed people and groups who requested them. The MPC provided training for 135 school nurses in Cecil and Frederick counties in Overall, 16 county school systems and day care centers used educational materials from the MPC in their classrooms. All ld, more than 24,000 pieces of educational materials were used in or handed out in schools throughout Maryland. National Poison Prevention Week (March 21-27, 2010) activities included mailings emergency departments and pharmacies throughout the state. A Poison Prevention Week poster contest for public schools in Washingn County was co-sponsored by the MPC and SafeKids Washingn County. The grand-prize winning poster has been used throughout the state promote poison safety. The MPC is also an important resource for the media. Poison center staff are often interviewed by television, radio, and print media for their expertise in poison-related sries. Professional education is targeted ward the special needs of health professionals. Programs and materials are designed help the clinician better manage poisoning and overdose cases that end up ixn a health care facility. In 2010, 68 programs were conducted by MPC staff at hospitals, fire departments, colleges, professional conferences (state, re gional, and national) and through webinars. These programs were attended by more than 4,300 physicians, nurses, EMS providers, pharmacists, physician assistants, and others. In 2010, monthly podcasts were recorded for broadcast on two websites devoted continuing education for health care providers: MedicCast.com and NursingShow.com. In all, there were 238,566 downloads of the podcasts, averaging 4,500 downloads per episode. The MPC also provides on-site training for physicians, pharmacists, and paramedics. More than 100 health professionals came the MPC in 2010 learn about the assessment and treatment of poisoned patients. 5 5

6 TOXTIDBITS AND POISON PREVENTION PRESS July 2010 ine Conta isole a Coca minant a veterinary. Levamisole, and ine powder and chemicals other drugs as a contaminant in coca a levamisolea variety of rted seen aminated with asingly repo you likely have amination in July are often cont rmer), has been incre cont nts recently, ad patie spre Illicit drugs ed dewo rted wide ine-poison of Washingn (livesck inistration repo levamisole. Urinalysis also positive anthelmintic If you have seen any coca Adm ent for rcem crack cocaine. nt as well. The Drug Enfo borders tested positive positive for cocaine were uct. The averprod U.S. poisoned patie of cocaine seized at imens that were umably dilute the cted in a small 45% of spec pres 70% dete 2009 when in late 2009 found that g added, but has also been isole is bein. Levamisole D.C. arrestees It is not clear why levam ples is 10%. in cocaine sam s. Lefor levamisole of levamisole only in trace amounts. cocaine user tion in ts entra in but age conc is, and as us xic effec ples of hero cause of serio ropenia and agranulocys necronumber of sam icated as the neut and skin has been impl blood cells, producing of vasculitis case reports ths, levamisole white In recent mon resses the production of addition, there have been In h. supp and deat vamisole with levamius infections g contaminated immediate a result, serio the drug bein seek levamisole. possibility of ds, be advised sis linked ed about the Cocaine users should, swollen glan or it. r, weakness ly should be warn s of cocaine g effects associated with of infections (high feve skin) that worsen quick Known user should life-threatenin lop signs and sympmsmouth or throat or on the th care professionals sole and the deve Heal the sure. sympms of tion if they abcesses in s after an expo cysis (with or without medical atten ful sores or ine week pain coca th, day of 1 nulo brea occur from plained agra questioned about the use e care and shortness of ent with unex Sympms can ortiv be oldon t resolve. isole in patients who pres Such patients should ping the exposure, supp. Routine xic osis. suspect levam ulitis, and/or skin necr Treatment consists of sp levamisole exposure last Pennsylvania be detected infection), vascthe presence of cocaine. within 5-10 days of the NMS Labs in unlikely and tested for ropenia usually resolves ver, facilities such as levamisole is er. that howe Neut note ;. n cent CSPI rtant antibiotics ct levamisole isole. It s impo ected cases the poiso Lisa Booze, PharmD, will not dete levam ng for testi y susp ogy com) will assa. Report any ( s after the last exposure beyond 48 hour Levam DID YOU KN year? OW THAT poison centers have received more than 600 calls about K2 this buy is currently legal poison se or spice. It U.S. eted as incen lated calls marijuana mark been more than 600 K2 re ana, effects such is a synthetic ted with mariju i, and Genie) U.S. There have what is expec effects are due n as Spice, Zoha least 40 other states in the s that are unlike unclear whether the xic K2 (also know ed xic effect land and at still rienc It s Mary in rs. expe K2 and use users have sion, and tremo in Many anxiety, confu centers so far n, chest pain, ed. a, hypertensio are dose-relat as tachycardi they if or dient an unknown ingre read ToxTidbits and Subscribe past issues at oison.com The MPC publishes a newsletter for health professionals: ToxTidbits, a monthly xicology update. The newsletter is faxed every Maryland emergency department and reaches more than 4,000 health professionals by . The MPC also publishes a newsletter aimed at the general public. Poison Prevention Press is a bimonthly newsletter highlighting various poison prevention pics. Since its launch in 2008, Poison Prevention Press has gained more than 120 subscribers. To receive ToxTidbits or Poison Prevention Press by , visit our website ( and click on Publications. Read and download all previous issues of both newsletters from the MPC website Poison n Press Preventio November/D ecember 2010 Proper Disp osal of Medicine Nonmedica l Use of Pr escription Volume 3, Issue 6 MayoClin not intended ic.com defines pres cript by the pres Take med othache cribing doct ion drug abuse as icine a. This may the use of or. This drug take In fact, eme seem like -bac a good idea includes taking a frien a prescription in a rgency room gram, often k prorisen dram way at the time d s pain visits invo atically in located at local law the past few lving the nonmedic, but it could be a pill for your enforcem recipe al use of narc years. According ent offices. otic pain reliefor disaster. the 2009 people age vers have National Surv Flush 12 medicines ey on Drug docr s orde or older admitted dow Use n the ilet or using a r) in the mon medicine prescription and Health (NSD drain only th prior without the UH), when the med bein 7 icine millio g surveyed patie they knew approval nonmedic n. Amo of a and did not mation shee nt inforally adults aged pay for it. docr, over half said ng individuals who (without a t tells you do so. used a pain See more misuse. Non18-25 from The nonmedical use they got the drug from som information of prescript 9. This was medical use eone age 12 or at the FDA ion drug driven main of pain older new website. ly by an incre s increased in substanc relievers was seco ase in pain To disca nd only e abuse. 1 Current relie marijuana rd medicine use in pers ver only mo drug overdose stati s at home, ons stics mix them r vehicle cras are and Preventio with kitty hes according alarming. Deaths litter n (CDC). from studies amples of coffee grou or used This incre from the Cen drug overdoses are opio nds. Put second relieving pain ids are oxycodon ase is mainly due ters for Dise the mixture prescript e, hydrocod in ion opioid ase Control cause deat, but when taken posable cont a disin o large one, and methadon painkillers. h. Because e. opioid pain of Exa lid or in ainer with killers is 10 docrs are currently a quantity they can They are very effec a holds have tive at slow brea times high bag and plac sealable treating pain thing enou opio er now e more aggr id pain the than it was gh prescribe container essiv 20 years more pills killers in their med in the trash ago. As a ely, the use of icine cabi than the patie cations in. nets than the home. 2 nt needs before. Ofteresult, more housefor their pain n, a physician, causing The nonm there be will edical use the 2009 lefver med of prescript Mon iion med Did you kno narcotic (incl iring the Future Survey, abouicines occurs in all w that grade stud uding oxycodone age groups. and hydrocod t 9.5% of 12 th-grad ents said According According it was fairl e reports that y easy or one), in the last 12 students said they 2008 the highest very easy used a months. Maryland drug over Over 35% get a Department dose deat hold of a of 12 th of Health h rate of is narc eme seen in and otic. rgency depa Hygiene data Mental rtment visits people age The CDC and abus e by adults The number involving leading caus, the prescription age 50 and from misuse older has -related deat e of injury more than doubled How can poisoning, h was we which inscribed for sp this trend? First cludes med you, only use icines and cine as soon by your docr. medicines illicit drug Second, disca preas s. you no longer medicines Approxim need it. Third rd unused mediin ately 70% ties missing. your house and be, be aware of poisoning alert of the If you think and overmedicine someone when there may be dose calls or is having has take quanti the Mary cine, call land Pois the poison a reaction taking n o much of a on someone center at 2009 invo Center in 1-80 else s medi lved a drug 1 right away.. amhs Medicine s a.gov/nsd 2 UH/2k9NS Post and share DUH/2k9R.cdc.gov/H esults.htm this edition omeandre brief_full_p #7.1 of Poison Prev tion Press creationalsafet age.htm and subscribe ention Pres y/poisonin g/ s with your the news colleagues, letter at www friends and.mdpoison family. Read.com past issues of Poison Prev en- ToxTidbits and Poison Prevention Press reach more than 4,000 health care providers and community members. MARYLAND POISON CENTER STAFF 2010 Direcr of Operations Bruce Anderson, PharmD, DABAT Statistician Yolande Tra, PhD Medical Direcr Suzanne Doyon, MD, FACMT Quality Assurance Specialist Lyn Goodrich, BSN, RN, CSPI Coordinar of Research and Education Wendy Klein-Schwartz, PharmD, MPH Specialists in Poison Information Lisa Aukland, PharmD, CSPI Denise Couch, BSN, RN, CSPI Randy Goldberg, RN, CSPI Michael Hiotis, PharmD, CSPI Michael Joines, BS Pharm, CSPI Jennifer Officewala, PharmD, MPH Eric Schuetz, BS Pharm, CSPI Kevin Simmons, BSN, RN, CSPI Paul Starr, PharmD, DABAT, CSPI Jeanne Wunderer, BS Pharm, CSPI Clinical Toxicology Fellows Patrick Dougherty, PharmD Samantha Lee, PharmD Clinical Coordinar Lisa Booze, PharmD, CSPI Public Education Coordinar Angel Bivens, RPh, MBA, CSPI Senior IT Specialist Larry Gonzales, BS Geographic Information Specialist Julie Spangler, MS 6 6 Program Administrative Specialist Connie Mitchell Office Assistants Nicole Dorsey Darren Skes

7 RESEARCH PUBLICATIONS AND PRESENTATIONS Dougherty PP, Klein-Schwartz W. Comparison of Octreotide and Dextrose Only for Treatment of Sulfonylurea Overdose in Children. University of Maryland School of Pharmacy Research Showcase, Baltimore, Md., April 13, Klein-Schwartz W, Doyon S, Dowling T. Evaluation of a Novel Charcoal Cookie Formulation for Drug Adsorption. American College of Clinical Pharmacy Spring Practice and Research Forum, Charlotte, N.C., April 26, Doyon S, Klein-Schwartz W. Ingestions of Prescription Cough and Cold Medications in Children Under 2 Years Reported Poison Centers. North American Congress of Clinical Toxicology, Denver, Colo., Oct. 11, Klein-Schwartz W, Doyon S, Dowling T. Evaluation of a Novel Charcoal Cookie Formulation for Drug Adsorption. Pharmacotherapy, 2010; 30(9): Klein-Schwartz W, Sorkin J, Doyon S. Impact of the Voluntary Withdrawal of Over-the-Counter Cough and Cold Medications on Pediatric Ingestions Reported Poison Centers. Pharmacoepidemiology and Drug Safety, 2010; 19: Klein-Schwartz W, Doyon S. Intravenous Acetylcysteine for the Treatment of Acetaminophen Overdose. Expert Opinion in Pharmacotherapy, 2010; Dec. 2 [Epub ahead of print]. Hayes BD, Klein-Schwartz W. Consistency Between Code Poison Center Data and Fatality Abstract Narratives for Therapeutic Error Deaths in Older Adults. Clinical Toxicology, 2010; 48(1): Anderson B, Ke X, Klein-Schwartz W. Potential for Erroneous Interpretation of Poisoning Outcomes Due Changes in National Poison Data System Reporting. Clinical Toxicology, 2010; 48(7): Benson BE, Farooqi MF, Klein-Schwartz W, Livitz T, Webb AN, Borys DJ, Lung D, Rose SR, Aleguas A, Sollee DR, Seifert SA. Diphenhydramine Dose-Response: A Novel Approach Determine Triage Thresholds. Clinical Toxicology, 2010; 48(8): Doyon S, Ripple M, Ali Z, Fowler D. Death Initially Wrongly Attributed Buprenorphine. Clinical Toxicology, 2010; 6(48): 633. (poster) Doyon S. Opoids. Emergency Medicine: A Comprehensive Guide. Tintinalli JE, Kelen GD, and Stapczyski JS, Eds., 7th edition, McGraw-Hill: New York, Doyon S. Anticonvulsants. Goldfrank s Toxicological Emergencies. Goldfrank LR, Flomenbaum N, Lewin NA, Howland MA, and Hoffman RS, Eds., 9th Edition, Applen & Lange: Norwalk, Conn., Bronstein AC, Spyker DA, Cantilena LR, Green JL, Rumack BH, Heard SE (contribur: Doyon S) Annual Report of the American Association of Poison Control Centers National Poison Data System: 27th Annual Report. Clinical Toxicology, 2010; 46: Dougherty PP, Klein-Schwartz W. Octreotide s Role in the Management of Sulfonylurea-Induced Hypoglycemia. Journal of Medical Toxicology, 2010 (June); 6(2): ACKNOWLEDGMENTS The following organizations deserve special thanks for their continued support of the Maryland Poison Center: University of Maryland School of Pharmacy University System of Maryland Maryland Department of Health & Mental Hygiene U.S. Department of Health and Human Services, Health Resources and Services Administration Maryland Institute for Emergency Medical Services Systems (MIEMSS) Safe Kids Maryland State and Local Coalitions PharmCon, Inc. Call or visit see how you can support the Maryland Poison Center. 7 7

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