Poison training staff

1. Drug and Poison Information
CLNI 522 (2021 -22)
Lecture 4:
TRAINING POISONS INFORMATION STAFF
University of Hail

2. A. Training new staff
An outline of the subjects that
should be covered in a training
programme for new poisons
information staff.
A detailed programme must be
developed by each centre
according to local circumstances.

3. 1. General aspects of training
The main components in a poisons information system
are the staff and the data bank.
To ensure an good poisons information service; that is
dependent on the smooth interaction between the
staff and the data bank.
The competence of the staff, crucial for the quality of
the information service provided, is dependent on
several factors:
1. basic education.
2. personal qualities.
3. specific training provided ‘on the job’.

4.  Appropriate period , if too short e.g. because of difficult
circumstances or overestimation of the knowledge and skills
of a new staff member, can prove
devastating and unfair to the trainee.
 All new staff members, irrespective of background and
personal qualities, need a solid and undisturbed training
period, ensuring good basic knowledge and a sound self-
confidence.
 The duration of the initial training period may vary, but it
should ideally be around three months.

5. 2. Areas to be covered in training
1. Main tasks and responsibilities of the
center, user groups
2. Organization and policies
3. Telephone service
4. Documentation of enquiries to the center
5. Information sources
6. Subject knowledge ‐ general
7. Subject knowledge – specific
8. Up‐dating the databank

6. 2.1 Main tasks and responsibilities of
the center, user groups
An explanation should be given of the
purpose of the center and its scope of
activities; these are sometimes
regulated by governmental instructions.
It is important to clarify the legal
aspects, what the center is expected to
achieve and just as important, what is
outside its mandate.

7. It is essential to clarify the authorized user
groups, e.g. the general public, health care
personnel, government authorities, the
media, and to discuss their different
requirements.
 It is crucial that poisons center staff should
not exceed their area of competence, and
new staff members should be encouraged
to consult with senior colleagues whenever
there is uncertainty.

8. 2.2 Organization and policies
 The external and internal organization of the
center should be described and discussed,
including the legal status of the center and
how it fits within the host institution, if relevant.
 Operational practices, such as how the staff
rotation will be practiced, should also be
described.
 Special attention should be given to policies
relating to confidentiality with regard to
product information, enquiries received by the
center and patient data.

9. 2.3 Telephone service
2.3.1 Policies
Each poisons center must
establish its own policy
with regard to how enquiries
should be handled.
This is, in turn, related to, for example,
the educational background of the
poisons information staff, internal
procedures for seeking advice from
senior colleagues, availability of
medical back‐up, and the actual user
groups.

10. Practical to have a routine procedure ready for these
situations.
 how to act and give priority to calls in case of a
queue,
 advice on transportation of patients,
 how to act in cases of suicide attempts or threat of
suicide where the toxic risk is not impending,
 how to handle common therapeutic errors e.g.
double dose or ingestion of another patient’s
medicine,
 how to deal with police and media when
pharmaceuticals have been stolen,
 general questions from the public about toxic and
lethal doses.

11. 2.3.2 Training at the telephone.
The best way of training new staff for the telephone service is through
“learning by doing under supervision“.
Poisons Information Staff ‐ Methods.
The objectives of the training are to:
 familiarize the trainee with the poisons information “dialogue” with
callers.
 familiarize the trainee with the call‐record form and how to complete it,
including documentation standards.
 familiarize the trainee with the sources of information available for
answering enquiries.
 explain the principles of assessing the risk of poisons exposures.
 build up the trainee’s subject knowledge.
 illustrate potential pitfalls in answering enquiries e.g. common
confusions of agent names.

12. After a satisfying assessment of the training period and the
competence of the trainee, he/she can start to take full responsibility
for answering enquiries after around three months.
Elements of particular relevance are
 questioning skills,
 listening skills,
 checking comprehension,
 empathy,
 dealing with angry,
 aggressive or upset people,
 and how to end a call.
additional external training courses, run by telephone communication
specialists, are very useful.

13. 2.4 Documentation of
cases and call sheets
Accurate and consistent documentation of cases is
fundamental for legal reasons as well as for poisons
centre statistics,
follow‐up studies and epidemiological research
A thorough understanding of
how to use the enquiry record sheet and
how to register the cases properly – whether on
paper or on computer – is therefore mandatory.
It is important to practice this, under supervision and
using real cases.

14. 2.5 Information sources
A poisons information centre may have access to many different
information sources:
internally produced files on the management of poisoning by
• chemical substances,
• pharmaceuticals and natural toxins,
• case data files,
• product information files,
• literature files,
• external databases,
• relevant toxicology handbooks and external consultants for special
cases.
Training how to use source information.
- demonstrated through exercises using real cases.

15. 2.6 Subject knowledge – general
Apart from these basic requirements, there is a
need for systematic education withregard to:
• routes of toxic exposure
• mechanisms of toxicity
• general management principles of poisoning:
decontamination,
• symptomatic and supportive care, mechanisms
of action of, and indications for, antidote
treatment, methods for enhancing elimination of
toxic substances
• the organization of antidote supply

16. 2.7 Subject knowledge – specific
With regard to the specific poisoning
pattern in a country or region, the most
important, dangerous and commonly
occurring toxic substances should be
identified.
 Based on this, selected pharmaceuticals,
chemicals, chemical products and
biological toxins should be subject to
detailed teaching sessions, led by senior
staff members.

17. It may be helpful for the trainee to have
a list of the most frequent chemical
products, pharmaceuticals, plants etc,
involved in calls from the public and
hospitals.
Also a list of the most dangerous
commercial products would be valuable
in order to avoid wasting time (e.g. in
spelling difficult names over the phone).
substances (such as chloroquine,
paraquat, organophosphorus pesticides,
cyanide),

18. 2.8 Up‐dating the data bank
The initial training should mainly aim at preparing new staff
members for answering telephone enquiries in an adequate way,
meeting the quality standards set by the centre.
Preparing poisons information monographs also
- provides training opportunities in finding,
-evaluating and synthesizing toxicological information.
- All these aspects can be covered in the longer term.
It is important to educate the trainee in the critical evaluation of
literature references and information in different databases (the
British Medical Journal has published guidelines on this).