Contents
- Introduction
- Objectives &Goals
- Clinical Service
- Documentations and Records
- Academic and Educational activities
- Research
- Future development and human resources
- Clinical toxicology Nurse
Introduction:
Medical toxicologists are involved in the comprehensive high-level care of patients with problems related to exposure to toxins such as:
1- Adverse drug events: injury resulting from the use of a drug
2- Medication overdose: the ingestion or application of a drug in quantities greater than recommended either accidental or intentional
3- Environmental poisoning: poisoning resulting directly from the individual’s environment, such as air and water pollution, pesticides or asbestos
4- Substance abuse: a harmful use of any substance with additive properties for mood- altering purpose
5- Acute withdrawal: a group of symptoms that occurs as a results of the cessation of addictive chemicals such as drug and alcohol
6- Snakes, scorpions and marine envenomation management
Everyday the health care provider faces a growing burden of chemical, pharmaceutical, and related toxicological exposures, which requires a distinct set of clinical skills. Poison centers and medical toxicology are able to offered these skills to providers and the public to improve the recognition, awareness and management of poisonings. Efforts are underway across the developing world, including here in the Arabian Gulf, to build much-needed capacity in clinical toxicology. SQUH as a leading hospital nationwide as well as in the whole region should have clinical toxicology service integrated as part of it is growing service.
Objectives:
1- The Medical toxicology service will allow physicians with advanced toxicology training to be available for emergent cases immediately, upon request, to help in the diagnosis and evaluation of patients who experience a poison and/or toxic exposure.
2- To improve patients’ overall care and efficiency in medical management. Studies show that this type of service results in decreased ICU stays and shorter hospital stays for the patient. It is also cost effective in that the patient needs fewer healthcare resources.
3- Cost savings by judicious use of adult and pediatric admission criteria for poisoning patients as medical toxicology consults have been shown to reduce unnecessary hospital admissions.
4- For SQUH to be recognized as a leading facility in the medical toxicology by making presence and maintaining contacts with other agencies dealing with various aspects of the prevention and treatment of poisoning including international conferences and meetings
5- To Monitor and maintain records for poisoning and overdose patients to survey the local statistics as well serve as good database for future researches
6- To provide send in guidelines for acceptance of drug and
7- Public health and toxicological surveillance this include (1) cases of drug and substance abuse, (2) foodborne illness outbreaks (e.g., botulism), (3) food/medication contamination, (4) detection of adverse drug reactions to new or older medications, (5) injuries from commercial and consumer products, and (6) pediatric poisoning trends.
8- To provide formal professional toxicology education and training to physicians, medical students and in residency training
Clinical Services:
Bedside consults:
Will provide diagnosis and management advice for seriously poisoning and overdose patients from ED and ICU and acutely admitted patients to medical or pediatric floors. Consultation will also be provided for toxicological laboratory requests, clinical interpretation of results in collaboration with toxicology lab.
Phone consults:
It can help in assessment and triage for poisoned and drug overdose patients if the call involve transferee from other hospitals, health care facility or EMS service and guide the management as needed plus providing guidance in management of acutely admitted patients
Timing:
The toxicologist is available for any toxicology consultations upto 11 pm .After that and in weekends, consults are available by phone for seriously poisoning patient in Emergency department or ICU by senior doctors.
Documentation and Records:
A special Toxicology consults form (Appendix 1) will be added to the HIS records .The documentation is prepared by the medical toxicologist bases on international standers. These records provide unique toxicological information that can be extremely valuable for future research and local facility audits. Diagnosis codes will be also added to the current HIS records in order to facilitate easy search and tracking for specific toxicology cases.
Academic and Educational Activities:
1- Teaching students and residents the medical management of many toxicological conditions. We also can deliver structured outreach sessions, providing information to staff working in acute medicine, emergency medicine, pediatrics and intensive care medicine. These can be in form of lectures or an intensive simulation or combination of both.
2- The medical toxicologist can be also involved in CME at hospitals, professional conferences, and other hospital education activities by providing updated and continuous knowledge about clinical toxicology and overdose cases management in adults and pediatrics.
Research:
As we know research is an integral part in development especially in a leading academic institute like SQUH mentioned. The collected toxicology consult data will be important sources of information. The medical toxicologist will be committed to supervise and conduct research and projects in this unique population as well as providing publication
Future Development and Human Resources
The evolution of the medical toxicology service will depend on local circumstances, needs and number of patients served. Ideally, there should addition of human resources in the future with training in medical toxicology to maintain the continuity of the service as well as advancement and development of the service. Those professional staff will be encouraged to undertake relevant research and contribute to the literature as well as maintaining the toxicology consults service coverage 24/7.
Clinical Toxicology nurse job description
A.Clinical Services:
1. Assess and implement needed care and follow up for toxicology-consulted patients seen or discussed with medical toxicologist.
2. Order and follow specific toxicology test either bedside, in collaboration with biochemistry toxicology laboratory or other available analytical toxicology in college of science.
3. Provide proper health education and consultation on prevention and assist in proper toxicology patient discharge and arrange for proper outpatient follow up of specific toxicology labs if needed .
4. Maintain effective communication and documentation on consulted toxicology patient and maintain proper communication with admitting or other specialty taking care of patient.
5. Handle , maintain stocking , be familiar with dosage and drug preparation and administration of all toxicology antidotes .
B.Education and Training:
1. Updated protocols and algorithm in management of poisoned patient with help and guidance of medical toxicologist
2. Organized and participate in continuous professional activities and teaching regarding clinical toxicology in hospital and other institutions
3. Attend conferences and courses and special workshop in clinical toxicology nationally and internationally
4. Prepare educational materials and leaflets for common poisoning prevention and management
5. Participate in exhibition done internal and externally to educate the public about poisoning and prevention
6. Be expert and teach special lectures about chemical exposure and decontamination with practical demonstration if needed
7. Prepare education toxicological presentation when needed
8. Participate in the national guideline of poison prevention update when needed .
C.Administration:
1. Establish communication link between medical toxicology service, pharmacy and analytical laboratories internally
2. Establish communication link between controlling and legislation agencies like ministry of agriculture and municipality for specific poison like pesticides be aware of prohibited list of pesticides in control
3. Report to concern agencies presence of public threat from specific exposure for regulation and prevention in collaboration with poison control in ministry of health
4. Establish a communication channel to the poison control center in ministry of health for needed collaborative work.
D.Research
1. Report monthly statistics of toxicology data including for drug overdose, chemical exposure, bites and stings to medical toxicologist and emergency department and others when needed.
2. Participate in toxicological related research including studies, publication, posters and abstracts
3. Conduct regular audits for management of toxicological cases and provide needed feedback for concerned staff
4. Assist other health care providers and students in conducting research related to toxicology
Examples of Toxicology Websites
Agency for Toxic Substances and Disease Registry
FDA Website
Drugs in Pregnancy and Lactation
PA Pesticide Website
American College of Medical Toxicology position statements
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