Main Article Content
Poison control centers, drug toxicity, medication errors, adverse drug reaction reporting systems
Poison centres are an underutilized source of information on adverse events related to medications, including therapeutic errors and adverse drug reactions.
To demonstrate the feasibility of using a poison centres’ electronic data to identify and describe adverse events related to medications.
This one-year, retrospective cross-sectional pilot study was conducted at one Canadian Poison Centre. All records from the IWK Regional Poison Centre database in Nova Scotia between November 1, 2007 and October 31, 2008 for unintentional exposures were abstracted for a descriptive data analysis.
An issue related to use of a medication was the main reason for 1,525 (32.5%) of 4,697 eligible calls. Of the 1,525 calls, 970 (63.6%) were coded as ‘unintentional-general.’ There were 470 (30.8%) calls for unintentional therapeutic errors and 61 (4.0%) for adverse drug reactions. The majority of calls involving medications were judged to have resulted in minimal or no toxic effect (78.4%). However, 3.3% of calls involving adverse drug reactions resulted in admission to a critical care unit (n=2). Approximately 1% of calls involving unintentional therapeutic errors resulted in admission to hospital (n=6).
Calls to poison centres provide a potentially valuable source of information on adverse events related to medications that are likely not reported elsewhere. Establishment of a mechanism to routinely share information from all Canadian poison centres with relevant national drug safety programs (e.g., MedEffectTM Canada) will provide a supplementary source of information and contribute to building capacity for detection of sentinel events and pharmacosurveillance.
2. Ernst FR, Grizzle AJ. Drug-related morbidity and mortality: updating the cost-of-illness model. J Am Pharm Assoc 2001;41:192-9.
3. Kidney T, MacKinnon NJ. Preventable drugrelated morbidity and mortality in older adults: a Canadian cost-of-illness model. Geriatrics Today 2001;4:120.
4. Thomsen LA, Winterstein AG, Sondergaard B, Haugbolle LS, Melander A. Systematic review of the incidence and characteristics of preventable adverse drug events in ambulatory care. Ann Pharmacother 2007;41(9):1411-26.
5. Elixhauser A, Owens P (AHRQ). Adverse drug events in US hospitals, 2004. Healthcare Cost and Utilization Project Statistical Brief #29, April 2007. Rockville (MD): Agency for Healthcare Research and Quality; 2007. Retrieved June 4, 2010. http://www.hcupus. ahrq.gov/reports/statbriefs/sb29.pdf
6. Budnitz DS, Pollock DA, Weidenback KN, Mendelsohn AB, Schroeder TJ, Annest JL. National surveillance of emergency department visits for outpatient adverse drug events. JAMA 2006;296: 1858-66.
7. Health Canada. MedEffectTM Canada. The Health Canada site; 2009. Retrieved June 4, 2010. http://www.hc-sc.gc.ca/dhpmps/ medeff/index-eng.php
8. Carleton BC, Smith MA, Gelin MN, Heathcote SC. Pediatric adverse drug reaction reporting: understanding and future directions. Can J Clin Pharmacol 2007;14(1):e45-e57.
9. Shah K, Barker KA. Out-of-hospital medication errors: A 6-year analysis of the national poison data system. Pharmacoepidem Drug Saf 2009;18:1080-5.
10. Chyka PA. Role of US poison centers in adverse drug reaction monitoring. Vet Human Toxicol 1999;41(6):400-2.
11. Chyka PA, McCommon SW. Reporting of adverse drug reactions by poison control centers in the US. Drug Saf 2000;23(1):87-93.
12. Cobaugh DJ, Krenzelok EP. Adverse drug reactions and therapeutic errors in older adults: a hazard factor analysis of poison center data. Am J Health-Syst Pharm 2006;63:2228-34.
13. Volans GN, Karalliedde L, Wiseman HM. Poison centres and the reporting of adverse drug events: the case for further development. Drug Saf 2007;30(3):191-4.
14. Vassilev ZP, Chu AF, Ruck B, Adams EH, Marcus SM. Evaluation of adverse drug reactions reported to a poison control center between 2000 and 2007. Am J Health-Syst Pharm 2009;66:481-7.
15. Watson WA, Litovitz TL, Belson MG, et al. The Toxic Exposure Surveillance System (TESS)©: Risk assessment and real-time toxicovigilance across United States poison centers. Toxicol Appl Pharmacol 2005;207:S604-10.
16. Spiller HA, Griffith JRK, Anderson DL, Weber JA. Poison centers detect an unexpectedly frequent number of adverse drug reactions to lisdexamfetamine. Ann Pharmacother 2008;42:1142-3.
17. Canadian Association of Poison Control Centres (CAPCC). Provincial Centres. The Canadian Association of Poison Control Centres site; 2008. Retrieved June 4, 2010. http://www.capcc.ca/provcentres/centres.html
18. Statistics Canada. Population by year, by province and territory. Statistics Canada site; 2010. Retrieved June 4, 2010.
19. Neuman T. Instructions for the American Association of Poison Centers Toxic Exposure Surveillance System (TESS)©. Aurora (CO): American Association of Poison Centers, 2001.
20. Hazell L, Shakir SAW. Under-reporting of adverse drug reactions: a systematic review. Drug Saf 2006;29(5):385-96.
21. Osborne C. Information management for busy practitioners: Adverse drug reactions: Investigating to Reporting. J Can Acad Child Adolesc Psychiatry 2010;19:46-7.
22. Canadian Institute for Health Information. Canadian Medication Incident Reporting and Prevention System (CMIRPS). The Canadian Institute for Health Information site; 2008. Retrieved June 4, 2010. http://secure.cihi.ca/cihiweb/en/downloads/C MIRPS_Charter_Exec_Summary_FINAL_e.p df
23. Holbrook A, Keshavjee K, Sebaldt R, et al. Evaluation of data sources to support pharmcosurveillance. Hamilton (ON): Health Canada; 2004. Retrieved June 4, 2010. http://individual.utoronto.ca/grootendorst/pdf/ Evaluation_of_data_sources_to_support.pdf