It’s 1:30 in the morning, and a new patient has been admitted to your floor. He’d been treated by the emergency department for an “accidental” methadone overdose, and when given naloxone became combative. Worse yet, his liver enzymes keep increasing for seemingly no reason. What is the next step? Call the Poison Control Center – even if this was already done by the emergency department physician. Though Poison Control is typically thought of as a consumer-based helpline, approximately 20% of the center’s calls are from healthcare professionals. The service is free and provides access to certified poison control specialists.In the above hypothetical, the poison specialist provides you – the attending physician – with instructions to administer lorazepam PRN for the apparent methadone withdrawal and requests an acetaminophen and aspirin level. They also advise that the half-life of naloxone is much shorter than methadone, and that the patient might need an additional dose if respiratory depression recurs.
A few hours later, labs in hand, you call back and talk to the toxicologist. Hearing the acetaminophen level of 40 mcg/mL, with an AST of 5000 and ALT of 3500, the toxicologist suggests you treat the patient with n-acetylcysteine. He also recommends some additional labs and a treatment protocol for the next few days.
The fact that you have called poison control not only provides invaluable medical information – state of the art protocols with direction from board certified toxicologists – but also provides a modicum of liability protection in the case of an ultimate law suit. If a plaintiff’s attorney alleges mismanagement of an overdose, failure to have called poison control can lead to the question of “are you a toxicologist?” followed by: “when was the last time you attended a toxicology conference?” No matter how simple the issue might seem, if within the contours of services provided by poison control it would be prudent to call.
Though many emergency department physicians and pediatricians are familiar with poison control, few hospitalists realize the breadth of the center’s services. In addition to dealing with typical poisons (e.g.: muriatic acid, bleach, organophosphates, etcetera), Poison Control also provides assistance with overdoses, medication errors, bites and stings, and much more. They are not a reporting agency, yet a record is created that can be accessed later in court – just enter the case number into your hospital’s EMR.
On the flip side, many patients can stay out of the hospital through a call to poison control – 69% of consumer calls are resolved through home management. Hospitals can thus decrease unnecessary ER visits by including information about the poison control hotline within their discharge packets.
So, when in doubt, call Poison Control – 1-800-222-1222 – the call can have a drastic impact on patient outcomes and simultaneously decrease liability for the physician as well as the hospital.
