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Biomedical subjects

B S Dean

Publications and source records attributed to B S Dean.

66 records · Page 4Linked to original sources
PubMed1987

Performance management: an essential program for poison centers.

Medico-legal liability and cost effectiveness mandate that poison information specialist performance be optimal. To maximize performance we developed and implemented a performance management program to achieve the objectives of high quality assurance in a cost-effective environment. The program can objectively assess, monitor, develop, discipline and financially compensate poison center staff. The performance standards, jointly developed by the staff and management, are the cornerstone of the program. They serve as a means of measuring and quantifying poison information specialist performance based upon compliance with responsibilities outlined in the standards. Our program enables the poison information specialist to optimize performance and also be cognizant of suboptimal work. Each staff person works with management to develop personal goals, objectives, and a plan for professional growth. Performance standards facilitate good management by improving communication, providing objective feedback, making orientation consistent, and providing an objective basis for promotion and compensation. They also provide an objective basis for dismissing unsatisfactory employees when performance is consistently suboptimal. Since personnel salaries account for 80% of a poison center's budget, effective performance management is essential.

Employee Performance Appraisal↗
PubMed1987

A program of poison center services to business and industry.

Poison information centers have been developed to serve the poison information, treatment, and prevention education needs of the residents within their regions. These services are generally provided and funded by hospital-based centers. A limited number of centers receive local and state government financial support. In general poison information centers are nonrevenue-generating and rely upon these sources of fiscal support. As cost containment within the health care industry becomes more critical, poison centers are falling victims to budget cuts and even being eradicated in the interest of saving money. The private sector has provided grants to poison centers, but this represents a short term solution to a long term problem--the need for consistent funding. Business and industry have been overlooked as a source of potential revenue. Our poison center has developed an extensive program of services for the private sector. These include providing 24-hour-a-day poison information service on their behalf; developing a workers' right-to-know program; identifying epidemiologic trends with their products, preparing exposure reports; etc. These services are provided for a specific fee which is determined by anticipated call volume, number of products to be included, medical and legal liability, etc. By providing services to the private sector, we have reduced the financial liability of our poison center by over 25%.

Commerce↗
PubMed1987

Poison center rotation for health science students.

There is a conspicuous absence of formal clinical toxicology education in health science programs. Routinely, clinical toxicology is not a required or elective course, yet an estimated 5% of emergency department visits and hospital admission are toxicologically related. In response to this need, a didactic and practicum program in clinical toxicology was developed and implemented within the operating framework of a regional poison information center. This model is based on a four week rotation, and participants include 5th year pharmacy students, 4th year medical students, 2nd and 3rd year emergency medicine residents. The didactic portion includes formal lecture on a core curriculum and self-directed study of select current review articles. With one-on-one supervision by the faculty member, the student participates in initial poison information consults, formulating toxicity assessments, implementing therapy recommendations, and follow-up calls. Participants present two seminars on toxicology topics during the rotation. At the conclusion of the rotation the participant is given a written multiple-choice examination to assess their knowledge of a required core of information. The examination is then reviewed with the participant to strengthen any obvious deficits in their learning experience.

Curriculum↗
PubMed1987

Personnel requirements of a poison information center.

Time use by poison information specialists at a poison information center was assessed to determine personnel requirements. To justify the current staff complement, to develop a formula for calculating future needs, and to monitor staff use, a time-use study was conducted by professional management engineers over 8 days in a 24-day period. Equal time was spent during each of three work shifts (0700-1500, 1500-2300, 2300-0700). Of 11 poison information specialists, 9 worked during the study period. Activity was divided into direct (handling poison information calls) and indirect (follow-up calls, quality assurance, continuing education, etc.) categories. Time study calculations for direct activity were based on 324 actual exposure calls. The average time to receive and document an initial poison exposure call was 8.7 minutes (range, 6.6-11.1 minutes). Indirect activity related to those calls averaged 12.9 minutes (range, 5.8-20.7 minutes), for a total of 21.6 minutes per call (87.3% of an eight-hour work shift). Nonproductive activity accounted for 12.7% of the time. Based on a mean (+/- S.D.) daily exposure volume of 104.7 +/- 1.35 calls, it was determined that 5.4 full-time equivalents per day were necessary to respond to an average day's call volume. At this center, the workload management study provided a sound basis for assessing current staffing needs and for justifying future changes in staffing based on actual call volume.

Humans↗
PubMed1986

Syrup of ipecac availability: before and after a poisoning.

A retrospective review was conducted of 1,230 human poison exposures in which syrup of ipecac was administered to determine the availability of this emetic. Ipecac was available in 41.1% of the homes, while 42.5% obtained it from the pharmacy. Eight and two tenths percent were referred to a health care facility, 2.9% obtained ipecac from a neighbor, 2.3% went to an emergency room prior to calling the poison center, and 3% obtained ipecac from other sources. A randomly selected sample of 150 of these 1,230 cases were contacted 6 months after their initial call to the poison center to determine any changes in the availability of syrup of ipecac in the home. Although almost 30% more homes had syrup of ipecac than previously, 22.2% of homes still did not have ipecac available, despite the previous poisoning experience. Greater effort should be made during follow-up to educate the public regarding ipecac and its use.

Drug Utilization↗
PubMed1986

Syrup of ipecac dosing ... How much is a tablespoonful?

Syrup of ipecac is a safe and effective emetic in pediatric patients. Previous reports demonstrate that syrup of ipecac-induced emesis is dose related. The failure rate and the time for emesis to occur is significantly greater when 15 ml is used compared to 30 ml. To reduce failure rates, efforts such as consuming the entire contents of a 15 ml or 30 ml bottle of syrup of ipecac or using kitchen measuring spoons are frequently employed. Since kitchen measuring spoons and flatware are commonly used to administer 1-2 tablespoons of syrup of ipecac, we measured the delivered dose of 30 standard flatware teaspoons to determine the accuracy of the spoons. The mean dose delivered by a kitchen measuring teaspoon was 5.5 ml (range 3 ml to 6 ml) and 12.7 ml (range 10 ml to 17 ml) for measuring tablespoons. This compares to the serving flatware teaspoon mean delivery volume of 5.8 ml (range 3 ml to 7 ml) and 9.5 ml (range 7 ml to 14 ml) for the flatware tablespoon. There is a significant disparity in the delivery volume of the utensils. We recommend the use of graduated medicine spoons or administration of the contents of an entire 30 ml bottle of syrup of ipecac to ensure optimal effects.

Humans↗
PubMed1986

The Pittsburgh Poison Center and its member hospital network.

When a poison information call involves a case that requires medical intervention, the staff of poison information specialists refer the poisoned patient to the emergency department of the nearest member hospital. This regionalization of treatment involving poison exposures eliminates the necessity of having an emergent patient rushed long distances to receive prompt and effective care. Facsimile terminals provide an efficacious method of enhancing communication of toxicology information to our member hospital treatment centers. A poison center is able to electronically transmit copies of written documents such as newly published journal articles or treatment protocols directly to the emergency department of the treating hospital. In turn, the facsimile terminal can confidentially transmit a copy of a poisoned victim's emergency record to the poison center. Data collection and documentation is strengthened. Transmission and receiving is accomplished within minutes.

Health Education↗
PubMed1986

An extensive review of commercial product labels the good, bad and ugly.

Cautions and warnings on consumer products play an important role in the prevention and treatment of poison exposures. Frequently those exposed will follow the directions before calling the poison center, physician or emergency room. An extensive label review of 200 commercial products was conducted to determine if medical treatment advice was correct, if the general public was able to comprehend warning statements, and if warnings were adequate. We conclude there are products available that provide precise, correct information. However, there are many that contain incorrect, misleading, and often dangerous information to an unsuspecting public. Various examples of both types are given to make the poison information specialist aware of what information is presented.

Drug Labeling↗
PubMed1985

Syrup of ipecac . . . 15 ml versus 30 ml in pediatric poisonings.

A prospective study was conducted to determine whether 30 ml of syrup of ipecac would produce a more rapid emesis than 15 ml in pediatric poisoned victims over twelve months of age. Data from 100 patients, where 15 ml of syrup of ipecac was administered, revealed an average time for emesis to occur of 25.82 minutes. Data from an additional 100 patients in which 30 ml of ipecac syrup was administered shows emesis to occur in 15.76 minutes. Clinically, six patients had repeated episodes of vomiting with 30 ml of ipecac; however, all were completely asymptomatic 60 minutes after ipecac administration. The difference of 10.06 minutes is statistically significant. Another aspect of the study evaluated whether the administration of clear liquids prior to or following ipecac substantially effected the onset of emesis. No differences were noted.

Child, Preschool↗
PubMed1985

Syrup of ipecac in children less than one year of age.

A prospective study was conducted to determine if children less than one year of age developed any complications from syrup of ipecac-induced emesis. All patients in the study were derived from cases received by the poison center. Syrup of ipecac (10 ml) was administered with clear fluids to 24 children less than twelve months of age (mean age 8.7 months; median age 9.0 months; range 3.0-12.0). The average time for the onset of emesis was 26.10 minutes. All children vomited with a single dose of syrup of ipecac. No adverse sequelae such as aspiration or prolonged episodes of emesis were observed. Contrary to the popular belief that emesis may be contraindicated in children less than twelve months of age, we believe that emesis can be safely induced in the home setting in these young children.

Age Factors↗
PubMedDate not supplied

Acute phenolphthalein ingestion in children. A retrospective review.

The Patient Management Exchange for this edition of the Journal features a research study on phenolphthalein ingestion done at the Pittsburgh Poison Center. The purpose of selecting this article was twofold. First, the material presented about the management of phenolphthalein ingestion in children is valuable information for health care practitioners working in ambulatory settings. Second, this work is an excellent illustration of how research can be incorporated into one's clinical practice. This study also demonstrates that research does not always involve a long and cumbersome process. Instead, research can evolve from the need of health care professionals to answer a simple question that is raised about a particular aspect of their patient practice.

Charcoal↗