Clinician Profile – Carol Wylie, Manager, Queensland Poisons Information Centre

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A toddler drinks a bottle of paracetamol. A grandmother is given another resident’s medication at her nursing home. A teenager falls unconscious after taking unknown pills at a festival. Poisonings come in many different flavours and are more common than many people might think. Worldwide they’re a major cause of morbidity and mortality and represent a significant public health threat, especially to children. 

Poisons Information Centres (PICs) are a vital part of the clinical landscape, and the first point of contact for the thousands of people exposed to poisonings each year. PICs help to improve patient outcomes by giving the public and clinicians trusted, current and evidence-based advice in situations of actual or suspected poisonings.

Health professionals are given specific advice on the management of poisoned and envenomed patients. Members of the public are given first aid instructions; advice on potential symptoms to watch for and when to seek medical attention in poisonings, bites and stings; and general advice on poisoning prevention.

This can help reduce unnecessary visits to hospital emergency departments, and in fact it’s been estimated internationally that $10 of potential healthcare spending is saved for every $1 spent on funding PICs.

Today we speak with Carol Wylie, Manager of the Queensland Poisons Information Centre (QPIC), a 17 year veteran managing the team. A qualified pharmacist, Carol has worked for the past 28 years in paediatric hospitals, including the old Royal Children's Hospital at Herston, and then relocating to the Lady Cilento Children’s Hospital in South Brisbane, where the QPIC is currently based in the Pharmacy Department.

A sophisticated phone triage service

Poisons Information Centres around Australia started out in paediatric pharmacy departments back in the 1960s, with children frequently getting into tablets before there were childproof lids and tablet strip packaging. Today we operate the Queensland Poisons Information Centre (QPIC) from Brisbane, and take phone calls from all over the state. We are part of a larger national network which includes poison centres in NSW, Vic and WA. Collectively we take calls across the country through our central phone number, 13 11 26. 

The QPIC team, from left: Jenny Stubbs, Genevieve Messina, Lauren Koch, Carol Wylie and Anna Goggin

At the Centre we provide advice to patients of all ages. This advice can range from reassurance where the exposure to a poison isn’t serious, to providing first aid advice, and ensuring that patients who are poisoned receive prompt and effective treatment. We try to prevent unnecessary visits to doctors and hospitals, and the Centre also plays a role in poisoning prevention. Essentially we are a sophisticated phone triage service. In Queensland we are completely staffed by pharmacists, who have received specialised training in toxicology and poisons information.

The centre receives approximately 33,000 calls per year - around 90 to 100 calls per day. Call lengths are generally short, only about 4 minutes on average.  Each call involves the poisons centre specialist making a risk assessment based on the information obtained in the call and giving advice to the caller. Our prime role is to advise on poisoning and suspected poisoning, as well as taking calls on bites and stings. It is a varied and very interesting job, with significant training and communication amongst the team. We speak to a large variety of callers, including some who are quite distressed.  We therefore need to be able to change our style or technique according to who we are talking to and the particular situation.

82% of calls involve exposures (poisoning incidents) or potential exposures. About half of these deal with unintentional or accidental poisonings, most of which involve toddlers accessing things they shouldn’t, such as cleaning products, paracetamol or household pesticides; as well as bites and stings.

About one in five calls are received from health professionals; GPs, hospital doctors, nurses, other pharmacists and ambulance staff. It is actually very common to have two or three calls about the same case made by different people. For example a call is received from someone at home where the poisoning occurred, then if it is a serious poisoning we may also speak with the ambulance that was called to the patient, and then we might receive a call from the emergency department where the patient was taken.

The centre receives a large number of calls regarding therapeutic errors, which can include situations where a person inadvertently receives the wrong medication, the incorrect dosage or medication at the wrong time. Some of these calls come from group homes or situations where a carer is managing a patient’s medication. Some carers have limited knowledge of medications, which can increase the likelihood of errors. 

Some calls to the centre can involve deliberate self-poisonings, i.e. self harm or suicide attempts.  These calls are managed in the same manner as other calls, with a thorough risk assessment made and accurate and timely advice given. 

Although not considered core business, the poison centre also receives drug information queries, particularly outside of standard business hours calls when others services, such as pharmacies are closed.

Mobilising poisons knowledge

Despite a large variation in call types, the risk assessment approach is similar. For each case we determine information about the product, chemical, drug, or creature. We also quantify the level of exposure. For example if a toddler has accessed paracetamol, we need to establish the strength, the dose form, pack size and an assessment on the amount taken. Poisonings with extended release products can be problematic, as the drug remains in the body for an extended period of time, so it is critical to determine the correct dosage form. We aim to get product details directly from the caller, but sometimes this is not possible. We therefore rely on drug and toxicology based resources to confirm the information we have been told.

We also collect data about the time of the exposure and the current state of the patient.

Once all available information is obtained from the caller, we conduct a risk assessment in order to determine the most appropriate advice to provide. This advice may range from reassurance, such as when a child has accessed a low toxicity product like silica gel, through to providing specific management advice to a doctor in the event of a serious poisoning. This may include advice about decontamination, ongoing monitoring, specific blood tests and use of antidotes. We may also give advice on whether a patient may require monitoring in a larger hospital, based on the severity of the poisoning and the facilities at the existing hospital.

Evidence-based resources

To conduct the risk assessment we pull together all of the available data, and use clinical information resources to confirm our advice or investigate further. We use the resources on the Clinical Knowledge Network (CKN) on a daily basis. We may be one of the largest users of this service.

It is essential for the resources we use to be current and evidence-based. For example we need to be aware of the latest evidence for managing poisonings, particularly when there are new drugs or chemicals involved. We need to be able to access data on the current strength, dose forms and brand names of medications to ensure our risk assessment is accurate. We also need to be able to determine when information was published and updated.

Additionally, due to the large volume of calls we receive it is essential that we can access data in a timely manner, i.e. the individual databases need to be responsive and accessible to us in real time.

CKN delivers all of that to us.

At any point in time we can have a variety of resources open on the desktop. We frequently access the Therapeutic Guidelines (eTG), which is an independent and evidence based Australian resource. Other toxicology resources include TOXINZ and Micromedex Poisindex. Other medication related resources we access include MIMSAMH and PubMed.

A decade of change

The area of poisoning and toxicology has evolved significantly over my time as Manager of the Queensland Poisons Centre. Our staff are involved in regular education and training, resulting in highly skilled pharmacists with very specialised knowledge. The centre has a permanently appointed Medical Director, based in the Toxicology Unit at the Princess Alexandra Hospital. This association has resulted in significant improvements in the type and manner in which advice is provided.

The QPIC is also actively involved in research and contributes to two major ongoing multicentre projects: one managed by the Clinical Toxicology Research Group; the Australian Toxicology Monitoring Study (ATOM) and also the Australian Snakebite Project (ASP).

The toxicology community across the country has become more established over the last 20 years. There is increasing Australian evidence-based toxicology research being published and with supporting programs like CKN we are able to access the information required, to provide an improved and thorough service to our patients.

Carol Wylie
Queensland Poisons Information Centre

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