When in doubt, check it out! The Regional Poison Control Center (RPCC) in Alabama is celebrating its 60th anniversary. As one of the oldest operating poison centers in the nation, specially trained pharmacists and nurses staff the toll free number 24/7, 365 days a year. Director Ann Slattery, DrPH, RN, RPh, DABAT shares helpful tips for parents and caregivers to avoid a trip to the emergency room.
Toll free: 1-800-222-1222 website: www.ChildrensAL.org/RPCC
Selected Podcast
Regional Poison Control Center Celebrates 60 Years
Featured Speaker:
Slattery is a clinical toxicologist boarded by the American Board of Applied Toxicology and has worked at the RPCC since 1982. She is also an adjunct professor at the McWhorter School of Pharmacy at Samford University, where she teaches toxicology. She is active on the American Association of Poison Control Centers accreditation and CDC quality committees, and the American Academy of Clinical Toxicology/American Board of Applied Toxicology credentialing and recertification committees. Slattery also serves on the Alabama Opioid Overdose and Addiction Council.
Ann Slattery, DrPH, RN, RPh, DABAT
Ann Slattery, DrPH, RN, RPh, DABAT is director of the Regional Poison Control Center (RPCC) at Children’s of Alabama. She received her undergraduate degrees in nursing and pharmacy from Samford University, and her Masters of Public Health (MPH) and Doctor of Public Health (DrPH) in environmental health and toxicology from the University of Alabama at Birmingham (UAB) School of Public Health. She completed a fellowship at the Centers for Disease Control and Prevention (CDC) with the Agency for Toxic Substances and Disease Registry (ATSDR).Slattery is a clinical toxicologist boarded by the American Board of Applied Toxicology and has worked at the RPCC since 1982. She is also an adjunct professor at the McWhorter School of Pharmacy at Samford University, where she teaches toxicology. She is active on the American Association of Poison Control Centers accreditation and CDC quality committees, and the American Academy of Clinical Toxicology/American Board of Applied Toxicology credentialing and recertification committees. Slattery also serves on the Alabama Opioid Overdose and Addiction Council.
Transcription:
Regional Poison Control Center Celebrates 60 Years
Tiffany Kaczorowski (Host): Welcome to Inside Pediatrics, a podcast brought to you by Children’s Hospital of Alabama in Birmingham. I’m Tiffany Kaczorowski, and today we’re talking to Ann Slattery who is director of the Regional Poison Control Center at Children’s of Alabama. Ann is a pharmacist, a nurse, and she has graduate degrees in environmental health and toxicology. Welcome Ann.
Ann Slattery (Guest): Thank you.
Host: So, the reason why we’re talking today is because the Regional Poison Control Center in Alabama is celebrating 60 years. That is a very long time.
Ann: And it’s fantastic. I’m so proud and excited. The very first poison center opened in 1953, and we opened up in 1958.
Host: Wow. Here in Alabama.
Ann: We’re the 14th oldest center in the nation.
Host: Wow. Out of 55 poison control centers, right?
Ann: Yes.
Host: Very good. So back in 1958, who was it that opened our regional poison control center?
Ann: Well the chief pediatric resident, Dr. Don Palmer, he started the poison center. The residents of that time at Children’s actually took the calls from other physicians around the state.
Host: Then when did it turn over to be more of a public entity where people could call in from their homes or from other healthcare facilities, say and not just from physician to physician?
Ann: Well eventually, the pharmacy at Children’s of Alabama took over the poison center. The pharmacists within the pharmacy answered the phone. Then in 1978 we established a toll-free statewide number so that everyone could call the poison center for free.
Host: Then eventually after that there became a national toll-free number that operates similar to 911. When you call it, it goes to your local regional poison control center, right?
Ann: Exactly. The 1-800-222-1222 is the same number for every poison center. So, if you called it from Alabama, you will get us. You call it in another state, you will get your local poison center.
Host: Okay, wonderful. So initially the phone line was physician to physician.
Ann: Correct.
Host: But then it became open to the public, as we said, with the 1-800 number. Tell me about the mix now.
Ann: When we first started the state wide 1-800 number, approximately 85 to 90% of our calls were from the public and only 10 to 15% from healthcare professionals. Now in 2018, 30% of our calls come from healthcare professionals in emergency departments.
Host: Is that significant?
Ann: It’s two-fold. That the public is getting their information from other sources, maybe the internet. Also, that unfortunately there are more dangerous medications out there. So ED’s are having to give us a ring for recommendations.
Host: Tell me how many calls you get that are about children versus adults versus senior citizens say.
Ann: 53% of our calls involve children less than six. If you look at all pediatric 18 and under, that’s 66% of our calls. The other 34% are adults. But we have in the last four years seen a 14% increase about the 65+ population.
Host: Oh, wow. Why is that? Is that just because of their own medications?
Ann: The majority of the calls are about therapeutic errors. They may double dose on medication. They may take their spouse’s medication. The 29% of people greater than 65 take over five medications a day. So, it can be confusing when you have all these medications and pill planners and then you may be taking care of a spouse who also has that many medications. That’s the majority of those calls.
Host: Now since we are at Children’s of Alabama, let’s talk about the calls about children.
Ann: It is going to be cleaning products and then cosmetics. Those are the top two because 75% of exposures occur while a product is in use. So that is going to be around while children are at home.
Host: Okay. Are they ingesting these products? They're smelling them? All kinds of things.
Ann: Everything. They’re splashing the cleaning products in their eyes or they're going up their nose. They may be taking a sip. They may be tasting the lipstick or eating some eyeshadow. So, we handle exposures to the skin, the eyes, any route.
Host: Okay. So, walk me through a typical scenario like that. What it looks like from your team’s point of view and then the reporting structure that eventually makes its way to the CDC and the parent that’s on the other line.
Ann: When you call a poison center, we are going to ask for your name and number. All calls are free and confidential. It’s not different than speaking to your physician. We are going to document the case. We are going to give you advice on how to handle. One of the things we’re very proud is in children less than six, those that originate in the home, we keep 90% at home and just follow them up to make sure they’re doing okay. So, we take that case, we document it. In less than 10 minutes it goes to the national poison data system. Physicians and pharmacists that are hired to surveil that data look at it basically instantaneously. At the same time, it’s going to the CDC and they're also looking at that data. So, they're looking clusters of nausea and vomiting around a zip code. Or if there’s a product that a lot of people are being exposed to, is there a problem? That type of thing.
Host: Wow. So, you mentioned the real time surveillance. This is the only agency, if you will, where there is real time surveillance going on in the United States, right?
Ann: Yes. Collectively poison controls are the only real time surveillance in the United States where healthcare professionals—at the regional poison control center we have nurses and pharmacists—that are receiving calls from both other healthcare professional and from the lay public. This data is going into one database from all 55 poison centers simultaneously. So, all of that is happening at once. Then it is being surveilled by the National Poison Data System by physicians and pharmacists that are trained to look at that data for clusters or any anomalies. At the same time, it’s going to the CDC.
Host: So, they're looking for any type of exposure that may be in a certain part of the country or a certain area in Alabama?
Ann: Every time we have an arsenic exposure, someone from NPDS – National Poison Data System—will contact me to verify whether they have well water or not because that is a problem with wells. So, we will get calls from NPDS or the CDC to verify what kind of data that we are submitting to NPDS.
Host: Well it’s good to know that there is a national organization. There are people who are monitoring this real time and looking at trends, looking at what’s going on throughout the country at any given time. Something else that you and I discussed that you were very proud is the amount of follow up calls. The amount of follow ups that our Region Poison Control Center does every year.
Ann: Yes. We received over 52,000 calls last year, which resulted in almost 40,000 charts. On those, we did close to 60,000 follow ups. So, we follow people up at home to make sure that they do okay if we are observing them at home. Then we do follow up hospital cases until a known outcome.
Host: What is the goal for that pharmacist or nurse on the other line?
Ann: Our goal is to give them accurate information about the exposure, and the best medical advice and course of treatment for that individual.
Host: Then you're also wanting to, if possible, keep them at home and not send them to an emergency department if they don’t have to go.
Ann: Exactly. Our claim to fame, well one of our claims to fame, is that we keep 82% of all ages at home. As I mentioned earlier, we’re able to keep 90% of those less than six at home and follow and make sure that they're fine so they don’t have to rush into an emergency department unnecessarily.
Host: Anything in particular that you're very proud of?
Ann: Well I am very proud of our outreach program. Our staff, on their off time, go out into the community and do health fairs and community events. We do public education and we’re very proud of that. Right now, our educator is actually working on a site impaired program. Once we have that established, it will be the first. Also, we have an app, Poison Perils, where you can look at poisonous snakes and poisonous insects and poisonous and non-poisonous plants and a few household items. There is no treatment recommendations on there. It is just for identification and just to keep people aware.
Host: Okay. You have a couple thousand people who have that app now.
Ann: Yes.
Host: Which is pretty good.
Ann: Yes.
Host: What are some of the things that when your outreach coordinators are going out into the public, when they go to the schools, when they’re talking to caregivers, what are some off those tips that they are giving them?
Ann: Well we really stress out of reach, out of sight. That’s very important because children, if they see the product then they could be tempted. We also tell people when I doubt, check it out. We’re a free call. If you're concerned, just call us and we can help alleviate your fears. That type of thing. Not to take medication in front of children. Don’t call medication candy, that type of thing.
Host: Sure.
Ann: Then if you do, let’s say, you go into someone else’s home where they don’t have child resistant closures—because there’s no such thing as child proof. Those closures are only going to keep them at bay maybe 10 to 15 minutes. Eventually if you leave them long enough, they’ll be able to open these closures, which many parents probably are already aware. That if you do have products that don’t have child resistant closures that you use lock boxes. We do recommend that when they go to visit grandparents and things like that. Because 46% of all prescription medications that are ingested by children are grandparent’s medications.
Host: Oh, wow. I remember you saying in one of our meetings, the medicine cabinet is the new drug dealer. That’s scary.
Ann: For adolescents right now, that is where they're getting their medications. Either from their parent’s medicine cabinet, their friends, their neighbors, their grandparents. That is where they’re getting their drugs.
Host: One of the videos that you guys recorded recently was just showing—to get off of the prescriptions and then onto maybe some of the toxic cleaning products in our households—is that some of these cleaning products are very colorful, the packaging. They may look like something that’s very familiar to a child.
Ann: There are a lot of lookalikes out there. Some of your blue beverages look just like glass cleaner. So that is very confusing for the young child.
Host: Yeah. You can see some of the reasons why these kids might pick up a household cleaner because it’s bright and colorful.
Ann: Yeah. And pills and tablets. They look like candy. It’s very confusing for them.
Host: Absolutely. Any other advice that you guys give to parents on a regular basis or adults that you share on a regular basis just trying to keep them safe?
Ann: Well we do recommend that they keep our number and have it available. If you have the app, you can actually push a button and call from our app. You can call and get a sticker or a magnet from us so that you have the number at all times. Give us a ring and let us help you decide if we have a problem.
Host: So, the website, if people want to check out the regional poison control center, is www.childrensal.org/rpcc. And Ann, the phone number one more time?
Ann: It’s 1-800-222-1222.
Host: And happy anniversary. Happy 60th anniversary to the Region Poison Control Center.
Ann: Thank you Tiffany.
Host: When in doubt--
Ann: Check it out.
Host: Thanks so much for joining us today.
Ann: Thank you.
Host: Thanks for listening to Inside Pediatrics. More podcasts like this one can be found at childrensal.org/insidepediatrics.
Regional Poison Control Center Celebrates 60 Years
Tiffany Kaczorowski (Host): Welcome to Inside Pediatrics, a podcast brought to you by Children’s Hospital of Alabama in Birmingham. I’m Tiffany Kaczorowski, and today we’re talking to Ann Slattery who is director of the Regional Poison Control Center at Children’s of Alabama. Ann is a pharmacist, a nurse, and she has graduate degrees in environmental health and toxicology. Welcome Ann.
Ann Slattery (Guest): Thank you.
Host: So, the reason why we’re talking today is because the Regional Poison Control Center in Alabama is celebrating 60 years. That is a very long time.
Ann: And it’s fantastic. I’m so proud and excited. The very first poison center opened in 1953, and we opened up in 1958.
Host: Wow. Here in Alabama.
Ann: We’re the 14th oldest center in the nation.
Host: Wow. Out of 55 poison control centers, right?
Ann: Yes.
Host: Very good. So back in 1958, who was it that opened our regional poison control center?
Ann: Well the chief pediatric resident, Dr. Don Palmer, he started the poison center. The residents of that time at Children’s actually took the calls from other physicians around the state.
Host: Then when did it turn over to be more of a public entity where people could call in from their homes or from other healthcare facilities, say and not just from physician to physician?
Ann: Well eventually, the pharmacy at Children’s of Alabama took over the poison center. The pharmacists within the pharmacy answered the phone. Then in 1978 we established a toll-free statewide number so that everyone could call the poison center for free.
Host: Then eventually after that there became a national toll-free number that operates similar to 911. When you call it, it goes to your local regional poison control center, right?
Ann: Exactly. The 1-800-222-1222 is the same number for every poison center. So, if you called it from Alabama, you will get us. You call it in another state, you will get your local poison center.
Host: Okay, wonderful. So initially the phone line was physician to physician.
Ann: Correct.
Host: But then it became open to the public, as we said, with the 1-800 number. Tell me about the mix now.
Ann: When we first started the state wide 1-800 number, approximately 85 to 90% of our calls were from the public and only 10 to 15% from healthcare professionals. Now in 2018, 30% of our calls come from healthcare professionals in emergency departments.
Host: Is that significant?
Ann: It’s two-fold. That the public is getting their information from other sources, maybe the internet. Also, that unfortunately there are more dangerous medications out there. So ED’s are having to give us a ring for recommendations.
Host: Tell me how many calls you get that are about children versus adults versus senior citizens say.
Ann: 53% of our calls involve children less than six. If you look at all pediatric 18 and under, that’s 66% of our calls. The other 34% are adults. But we have in the last four years seen a 14% increase about the 65+ population.
Host: Oh, wow. Why is that? Is that just because of their own medications?
Ann: The majority of the calls are about therapeutic errors. They may double dose on medication. They may take their spouse’s medication. The 29% of people greater than 65 take over five medications a day. So, it can be confusing when you have all these medications and pill planners and then you may be taking care of a spouse who also has that many medications. That’s the majority of those calls.
Host: Now since we are at Children’s of Alabama, let’s talk about the calls about children.
Ann: It is going to be cleaning products and then cosmetics. Those are the top two because 75% of exposures occur while a product is in use. So that is going to be around while children are at home.
Host: Okay. Are they ingesting these products? They're smelling them? All kinds of things.
Ann: Everything. They’re splashing the cleaning products in their eyes or they're going up their nose. They may be taking a sip. They may be tasting the lipstick or eating some eyeshadow. So, we handle exposures to the skin, the eyes, any route.
Host: Okay. So, walk me through a typical scenario like that. What it looks like from your team’s point of view and then the reporting structure that eventually makes its way to the CDC and the parent that’s on the other line.
Ann: When you call a poison center, we are going to ask for your name and number. All calls are free and confidential. It’s not different than speaking to your physician. We are going to document the case. We are going to give you advice on how to handle. One of the things we’re very proud is in children less than six, those that originate in the home, we keep 90% at home and just follow them up to make sure they’re doing okay. So, we take that case, we document it. In less than 10 minutes it goes to the national poison data system. Physicians and pharmacists that are hired to surveil that data look at it basically instantaneously. At the same time, it’s going to the CDC and they're also looking at that data. So, they're looking clusters of nausea and vomiting around a zip code. Or if there’s a product that a lot of people are being exposed to, is there a problem? That type of thing.
Host: Wow. So, you mentioned the real time surveillance. This is the only agency, if you will, where there is real time surveillance going on in the United States, right?
Ann: Yes. Collectively poison controls are the only real time surveillance in the United States where healthcare professionals—at the regional poison control center we have nurses and pharmacists—that are receiving calls from both other healthcare professional and from the lay public. This data is going into one database from all 55 poison centers simultaneously. So, all of that is happening at once. Then it is being surveilled by the National Poison Data System by physicians and pharmacists that are trained to look at that data for clusters or any anomalies. At the same time, it’s going to the CDC.
Host: So, they're looking for any type of exposure that may be in a certain part of the country or a certain area in Alabama?
Ann: Every time we have an arsenic exposure, someone from NPDS – National Poison Data System—will contact me to verify whether they have well water or not because that is a problem with wells. So, we will get calls from NPDS or the CDC to verify what kind of data that we are submitting to NPDS.
Host: Well it’s good to know that there is a national organization. There are people who are monitoring this real time and looking at trends, looking at what’s going on throughout the country at any given time. Something else that you and I discussed that you were very proud is the amount of follow up calls. The amount of follow ups that our Region Poison Control Center does every year.
Ann: Yes. We received over 52,000 calls last year, which resulted in almost 40,000 charts. On those, we did close to 60,000 follow ups. So, we follow people up at home to make sure that they do okay if we are observing them at home. Then we do follow up hospital cases until a known outcome.
Host: What is the goal for that pharmacist or nurse on the other line?
Ann: Our goal is to give them accurate information about the exposure, and the best medical advice and course of treatment for that individual.
Host: Then you're also wanting to, if possible, keep them at home and not send them to an emergency department if they don’t have to go.
Ann: Exactly. Our claim to fame, well one of our claims to fame, is that we keep 82% of all ages at home. As I mentioned earlier, we’re able to keep 90% of those less than six at home and follow and make sure that they're fine so they don’t have to rush into an emergency department unnecessarily.
Host: Anything in particular that you're very proud of?
Ann: Well I am very proud of our outreach program. Our staff, on their off time, go out into the community and do health fairs and community events. We do public education and we’re very proud of that. Right now, our educator is actually working on a site impaired program. Once we have that established, it will be the first. Also, we have an app, Poison Perils, where you can look at poisonous snakes and poisonous insects and poisonous and non-poisonous plants and a few household items. There is no treatment recommendations on there. It is just for identification and just to keep people aware.
Host: Okay. You have a couple thousand people who have that app now.
Ann: Yes.
Host: Which is pretty good.
Ann: Yes.
Host: What are some of the things that when your outreach coordinators are going out into the public, when they go to the schools, when they’re talking to caregivers, what are some off those tips that they are giving them?
Ann: Well we really stress out of reach, out of sight. That’s very important because children, if they see the product then they could be tempted. We also tell people when I doubt, check it out. We’re a free call. If you're concerned, just call us and we can help alleviate your fears. That type of thing. Not to take medication in front of children. Don’t call medication candy, that type of thing.
Host: Sure.
Ann: Then if you do, let’s say, you go into someone else’s home where they don’t have child resistant closures—because there’s no such thing as child proof. Those closures are only going to keep them at bay maybe 10 to 15 minutes. Eventually if you leave them long enough, they’ll be able to open these closures, which many parents probably are already aware. That if you do have products that don’t have child resistant closures that you use lock boxes. We do recommend that when they go to visit grandparents and things like that. Because 46% of all prescription medications that are ingested by children are grandparent’s medications.
Host: Oh, wow. I remember you saying in one of our meetings, the medicine cabinet is the new drug dealer. That’s scary.
Ann: For adolescents right now, that is where they're getting their medications. Either from their parent’s medicine cabinet, their friends, their neighbors, their grandparents. That is where they’re getting their drugs.
Host: One of the videos that you guys recorded recently was just showing—to get off of the prescriptions and then onto maybe some of the toxic cleaning products in our households—is that some of these cleaning products are very colorful, the packaging. They may look like something that’s very familiar to a child.
Ann: There are a lot of lookalikes out there. Some of your blue beverages look just like glass cleaner. So that is very confusing for the young child.
Host: Yeah. You can see some of the reasons why these kids might pick up a household cleaner because it’s bright and colorful.
Ann: Yeah. And pills and tablets. They look like candy. It’s very confusing for them.
Host: Absolutely. Any other advice that you guys give to parents on a regular basis or adults that you share on a regular basis just trying to keep them safe?
Ann: Well we do recommend that they keep our number and have it available. If you have the app, you can actually push a button and call from our app. You can call and get a sticker or a magnet from us so that you have the number at all times. Give us a ring and let us help you decide if we have a problem.
Host: So, the website, if people want to check out the regional poison control center, is www.childrensal.org/rpcc. And Ann, the phone number one more time?
Ann: It’s 1-800-222-1222.
Host: And happy anniversary. Happy 60th anniversary to the Region Poison Control Center.
Ann: Thank you Tiffany.
Host: When in doubt--
Ann: Check it out.
Host: Thanks so much for joining us today.
Ann: Thank you.
Host: Thanks for listening to Inside Pediatrics. More podcasts like this one can be found at childrensal.org/insidepediatrics.