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This project determined whether the massive distribution of poison center telephone number (Poison Help 800-222-1222) awareness stickers via a direct mail campaign, as a passive education technique, enhanced poison center awareness and was cost-effective. A regional ambulance service conducts an annual membership renewal/solicitation drive via mail to all residents within its service area. A sheet of Poison Help stickers was inserted in each ambulance service recruitment envelope and mass-mailed in 3 separate mailings over 4 w to 51% of households in a single county (population 368,983) at a direct expense of 4,477 dollars. Call volumes from zip codes that received the mailing were compared to an identical benchmark time period from the previous year. Analysis of call volume data over the study period revealed that call volume decreased by 1.3% during the study period. A mass-mail campaign to enhance poison center awareness failed to increase poison center call volume from the targeted county and, cannot be construed as cost-effective.

On January 1, 1999, the Washington Poison Center implemented Toxicall; 6 mo later we measured its impact on time devoted by staff for telephone interchange, information retrieval from other than Poisindex, and documentation, and to compare it with prior studies of our conventional paper-pencil system. Previous "time and motion" studies over the past decade, using random alarm devices (Devilbiss Electronics) provided data for comparative purposes. We developed a computer-based alarm system for timing and station selection and for recording observed behaviors. Over a 6-w period, 211 calls were analyzed; the percentage of time involved for each call was compared to a 1993 study. An increased, rather than anticipated decreased, documentation effort was observed (p< 0.05), but staff participation in activities other than those listed fell dramatically suggesting increased staff efficiency. Although documentation efforts consume so much time, Toxicall provided the non-debatable benefit of eliminating illegible staff handwriting!

Nuclear, biological and chemical (NBC) terrorism countermeasures are a major priority with municipalities, healthcare providers, and the federal government. Significant resources are being invested to enhance civilian domestic preparedness by conducting education at every response level in anticipation of a NBC terroristic incident. The key to a successful response, in addition to education, is integration of efforts as well as thorough communication and understanding the role that each agency would play in an actual or impending NBC incident. In anticipation of a NBC event, a regional counter-terrorism task force was established to identify resources, establish responsibilities and coordinate the response to NBC terrorism. Members of the task force included first responders, hazmat, law enforcement (local, regional, national), government officials, the health department, and the regional poison information center. Response protocols were developed and education was conducted, culminating in all members of the response task force becoming certified NBC instructors. The poison center participated actively in 3 incidents of suspected biologic and chemical terrorism: an alleged anthrax-contaminated letter sent to a women's health clinic; a possible sarin gas release in a high school: and a potential anthrax/ebola contamination incident at an international airport. All incidents were determined hoaxes. The regional response plan establishes the poison information center as a common repository for all cases in a biological or chemical incident. The poison center is one of several critical components of a regional counterterrorism response force. It can conduct active and passive toxicosurveillance and identify sentinel events. To be responsive, the poison center staff must be knowledgeable about biological and chemical agents. The development of basic protocols and a standardized staff education program is essential. The use of the RaPiD-T (R-recognition, P-protection, D-detection, T-triage/treatment) course can provide basic staff education for responding to this important but rare consultation to the poison center.

A telephone survey of a random sample of callers to the New Zealand National Poisons and Hazardous Chemicals Information Centre (NPC) was undertaken to assess public satisfaction with, and knowledge of, the NPC and to determine whether the NPC was meeting the needs of its users. The response from a sample of 433 individuals (354 members of the general public and 79 health professionals) was 79%. Maori and Pacific Island people were under--represented in the sample. Overall the level of satisfaction with the NPC was high with 91% of the respondents finding the information they received very useful. If the NPC had not been available, 81% of the public would have sought advice from a medical facility and 59% would have visited such a facility. It was estimated that the NPC could be saving the public health services in New Zealand (NZ) up to NZ $1.3 million annually. It was concluded that the NPC was meeting the needs of current users, although greater public awareness and improved access are needed particularly for Maori and Pacific Island people.

Self-scheduling was introduced to our Poison Control Center (PCC) as an alternative method of scheduling. The traditional method of scheduling was becoming an overwhelming task for the managing director, and the specialists' individual needs were not adequately met. Therefore, self-scheduling was implemented to meet the needs of the PCC as well as create the feelings of empowerment and autonomy for the specialists. The staff was educated on the process of self-scheduling. This process involved assessing, planning, implementing and evaluating. Using the democratic process, guidelines were established for shift hours, shift rotation, weekends, vacation and holidays. The plan included assigning a specialist as "schedule mediator". The mediator was responsible for assessing the schedule for any over- or under-staffing and negotiating schedule changes between the specialists. When the schedule's gaps had been negotiated, the completed schedule was posted. Finally, the staff completed a questionnaire to evaluate self-scheduling. All of the specialists strongly agreed that there had been a positive outcome from implementing self-scheduling. Their comments included "enjoyed the flexibility in doing her own schedule" and "enjoyed the participating in the operation of the PCC".

In order to justify dedicated staff for night calls, improve the quality of our handling of these calls, and qualify for certification by the AAPCC, we sought an alternative to hiring dedicated night staff. We offered our certified staff members the opportunity to fulfill part of their regular duties answering night calls from home. We set them up with a computer system, dedicated telephone line, texts and consultant information. They were able to access the Poison Center hotline computer via a remote access program. A significant increase took place in the number of documented calls to the Poison Center during the midnight to 8:00 am shift. Quality of documentation also improved significantly and level of service has been complemented by callers. The remote access method is a viable way for a small Poison Center to cover the night shift with certified, reliable, capable staff. This method of call answering has solved our major problem of hiring night staff who would satisfy requirements and provide excellent service.

MPCS developed a model for poison control which includes a member hospital network besides the regional information center. The network provides a mechanism for establishing information center credibility among hospitals and securing additional funds. Supported by the state hospital association, the membership network has contributed 22% of revenues for system's operations from annual dues of +305 to +882/hospital. Dues entitle hospitals to free managements and publications and public education materials at reduced price. The network has maintained on average 100 member hospitals per year with a 90% continuity rate. Members include 88 (79%) of 112 acute care regional hospitals (88% of teaching, 91% of large and 67% of small community hospitals). Network advantages to hospitals are the incentive to consult with MPCS without losing patients and staff education through consultation and rounds. Advantages to MPCS are an increase in staff and toxicology fellow expertise through consultation, teaching, and protocol formulation, research sites, and professional and public calls.

A prospective study was conducted to compare access-to-information times using Poisindex on microfiche versus the computerized version. A time study was conducted in 2 separate phases in the Pittsburgh Poison Center by professional time management engineers who observed certified poison information specialists. The microfiche phase was completed as a portion of a more extensive time management study, and the phase to evaluate the computerized version was completed 9 months after the system had been implemented to insure standardized competency. Access time was defined as the length of time required for the initial information to appear on either the microfiche viewer or the CRT. The average access time for microfiche use was 37.2 sec compared to 18.0 sec for the computerized version, an improvement of 106%. Based upon an annual volume of approximately 40,000 cases, the 19.2 sec savings in access time results in a time savings of 213 hours per year. To generate time savings equivalent to a 0.5 FTE position, a reduction of 1.47 min/call in the overall processing time is necessary. However, the time savings may improve patient care through easier and more extensive access to information and may allow more time for thorough documentation.

In 1984 the Poison Center installed a Dacon ACS-46 Automatic Call Sequencer. This device is connected to all incoming poison information lines (with the exception of a specially designated 911 line) and acts as an interface between callers and Poison Information Specialists during periods of heavy call loads. While the use of a call sequencer could never be termed ideal, such use offers a number of specific benefits in situations that are frequently encountered in Poison Center work. These benefits include: significant reduction in staff stress, caller assurance that a correct number has been reached, efficient triage of incoming calls, and accumulation of accurate incoming call data. Data input parameters of this system include: total calls offered, dropped calls, calls over alarm time, average time for completed calls, average time for dropped calls, and completed and dropped hold time data bins.

To develop a strategy for the development and implementation of future poison center services and prevention education activities, a telephone survey was conducted within the greater metropolitan region. The survey consisted of 58 questions developed to research information in 5 broad categories of consumer awareness of: poisoning accidents and their sources; Mr Yuk and the poison center; consumer response to poisonings; and education. The questionnaire was pretested and then conducted by experienced interviewers. Four hundred interviews were conducted over 12 consecutive days between the hours of 9:00 am and 8:00 pm to accomodate both working men and women. Respondents with a college education had significantly greater awareness of the poison center and Mr Yuk. Sixteen and 6/10 percent of the respondents had actually used the poison center. Homes with parents working outside of the home had a higher incidence of poisoning exposures. Respondents under 50 years of age had a significantly higher awareness of the poison center than those older than 50 (48% vs 27%). Furthermore, more respondents living in households of four or more knew about the poison center compared to smaller households (50% vs 36%). Only 5.5% of the respondents used the Mr Yuk sticker to obtain the telephone number of the poison center. Awareness of the poison center was 89.8%.

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.