Background Cases of intoxication are commonly seen at paediatric emergency centres. The knowledge of emergency medicine clinical pharmacists in toxicological emergencies is highly valuable. A pharmacist-managed toxicology consultation service has been implemented at our paediatric emergency centre. There has been no previous evaluation of this service.
Purpose To assess the appropriateness of a treatment and monitoring plan. This evaluation also aimed at characterising the epidemiology of the consultations and identify areas for improvement.
Material and methods A list of all patients who presented to the paediatric emergency centre with drug ingestion in 2016 was obtained. Subsequently, a standardised data extraction tool was used to extract the following information from patients’ electronic health records: demographics, decontamination, investigations, supportive therapy, antidote, and patient disposition or discharge plans. Then, management was compared with the standard management illustrated in lexi-tox and micromedex, which were the references followed at our hospital, and judged for appropriateness accordingly. Data was analysed using descriptive statistics.
Results Seventy-six patients were identified. Forty-eight were males and median age was 3 (2–4) years. Three patients presented with intentional drug ingestion, while the rest were considered accidental. A pharmacist was consulted for 83% of the cases. Household agents were the most common agents of toxicity accounting for 29% of the cases followed by vitamins (17%) and paracetamol (9%). Decontamination was indicated in 18 (23.6%) patients, of which 13 had undergone decontamination appropriately. The administration of activated charcoal was the method of decontamination used for all patients. One patient received activated charcoal, although not indicated. Required investigations were ordered for all except one patient who needed follow-up after a few days. On the other hand, unnecessary investigations were done for nine patients. Antidote was given in three cases, one of them was not indicated. Supportive measures were required and provided for two patients only. Six patients were monitored at the hospital, although not required and one patient was discharged immediately despite needing observation.
Conclusion The majority of paediatric toxicology cases were 4 years or younger, mainly being accidental rather than intentional ingestion. Based on this evaluation, there appears to be increased use of unnecessary investigations and under-utilisation of decontamination.
References and/or acknowledgements None.
No conflict of interest.
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