Medication Safe - Dr. Ben Tsutaoka

We came across an internet site with some recommendations regarding “First Aid for Poisoning”.

The recommendations included:

1. Find the container. Identifying the poison is the first step in selecting the right antidote.

2. Call the nearest doctor, giving him all the details as clearly as possible.

3. Rush the victim to hospital if you are close enough. Take the poison along with you in its original container, so the doctor will know what antidote to use.

4. UNIVERSAL ANTIDOTE: Neutralize the poison if you know whtat it is. If you don’t  here is the universal antidote:

• Wood charcoal, 2 parts (burned toast may be substitute)
• Milk of magnesia, 1 part
• Tannic Acid, 1 part (strong tea)
• Gave 1 teasponful of a glass of water.

5. Induce vomiting. Lay the child your kness with his head down, and place your fingers at the back of his throught to induce vomiting. For an older child or adult, give one or two glasses of milk or white of an egg. Use water if nothing else is handy. A teasponful of salt added to the water will increase the tendency to vomit.

Some advice out there, may do more HARM than good. There is little in the above recommendations that we would agree with. If you think your child, yourself, or someone you know, may have touched, tasted or breathed something that may be harmful: DON’T GUESS. BE SURE.

Call your poison control center for advice. Poison Control Centers can be reached by calling 1-800-222-1222.

From the UK.

The Health Protection Agency commissioned National Poisons Information Service (NPIS) has reported an 11% rise in the number of telephone enquiries from health professionals relating to incidents involving children aged under 10 years.

Around 92 per cent of the 18,864 enquiries were caused by the accidental poisoning of children with substances found in the home such as ibuprofen, paracetamol and the desiccant silica gel.

Professor Simon Thomas, director of NPIS (Newcastle), added: “The high proportion of our enquiries that involve children continues to be a concern. Parents and guardians should do all they can to keep children away from contact with potentially harmful medicines and from chemicals used in the house or garden. Where possible, these substances should be kept locked away and in child-proof containers.”

The entire press release can be found here: http://www.hpa.org.uk/webw/HPAweb&HPAwebStandard/HPAweb_C/1252326273170?p=1231252394302

We came across some great recommendations, regarding childproofing the bathroom for medicines, posted on consumerreports.org from April 2007.

 The full article can be found here: http://www.consumerreports.org/cro/babies-kids/resource-center/keeping-baby-safe-404/bathroom/0704_keeping-baby-safe_bathroom.htm?INTKEY=195BSE0

We’ll post the pertinent information here.

Medicines. Keep medicines away from bedside tables and install a lock on the medicine cabinet well out of your child’s reach. You can also store medications in a childproof, locked box kept on a high shelf outside the bathroom. Put vitamin supplements out of reach, too–iron pills and vitamins containing iron are leading child poisoners. Choose child-resistant packaging for prescription and over-the-counter drugs and vitamin supplements. Never keep medicines inside a purse in containers without childproof caps. Store visitors’ handbags out of reach, such as on a high shelf. You never know. They might contain pill bottles without these caps, or small items that could be choking hazards. Discard expired drugs in their child-resistant packaging; don’t just empty the contents in the garbage.

This article ran in the Atlanta Journal constitution. Based on a report from the CDC, the leading cause of accidental poisonings among American children can be found in the family medicine cabinet.

TUESDAY, Aug. 4 (HealthDay News) — The leading cause of accidental poisonings among American children can be found in the family medicine cabinet, a new government report shows.

Each year in the United States, more than 71,000 children aged 18 and younger are seen in emergency rooms for unintentional overdoses of prescription and over-the-counter drugs, the researchers found.

In fact, more than two-thirds of emergency department visits are due to poisoning from prescription and over-the-counter medications — that’s more than double the rate of childhood poisonings caused by household cleaning products, plants and the like, the team from the U.S. Centers for Disease Control and Prevention said.

“Medication overdoses are most common among 2-year-olds,” added lead researcher Dr. Daniel Budnitz, director of the CDC’s Medication Safety Program in the division of health-care quality promotion. “About one out of every 180 2-year-olds visits an emergency department for a medication overdose each year.”

Dr. Robert Geller, a professor of pediatrics at Emory University School of Medicine and medical director of the Georgia Poison Center, said that “the number children seen in the emergency room due to overdoses that are unintentional or medication errors is remarkable.”

Geller noted that many more people reach out to poison control centers for help than show up at the hospital. “Right now, poison centers are having their funding cut,” he noted. “If poison centers are less available, the number of children going to emergency rooms will rise.”

More than 80 percent of these overdoses are due to unsupervised ingestion, Budnitz noted. “Basically, it’s young children finding and eating medicine without adult supervision,” he said. “They are found with an empty bottle or pills in their mouth or something, and they are taken to the emergency department.”

In addition, medication errors by caregivers or adults and misuse of drugs by preteens and teens cause about 14 percent of accidental poisonings, Budnitz said. “Basically, that’s not following directions,” he said.

The full news article can be found here: http://www.ajc.com/health/content/shared-auto/healthnews/drab/629675.html. 

We will attempt to link to the published article when it becomes available.

Update, the full text of the published article,

Medication overdoses leading to emergency room visits in children. Schillie SF, Shehab N, Thomas KE, Budnitz DS., Am J Prev Med. 2009 Sep;37(3):181-7., can be found here: http://www.ajpm-online.net/article/PIIS0749379709003894/fulltext.

Here are some good medication safety tips from Brian Wolfe, Pharm.D., BCPS who is the inpatient clinical pharmacy coordinator at Ball Memorial Hospital. The article was originally posted online by thestarpress.com on June 22, 2009.

The full article can be found here: http://www.thestarpress.com/article/20090622/LIFESTYLE/906220304.

Are there any special precautions I should take with my children’s medicines?

ASHP recommends following these five tips:

 From the PRNewswire, June 4 2009

The entire press release can be found here: http://sev.prnewswire.com/null/20090604/PH2747104062009-1.html

Annual Hands on Home Safety Campaign Encourages Families to Take Action to Protect Against the Leading Causes of Accidental Home Injury

Just in time for Home Safety Month in June, the national, nonprofit Home Safety Council (HSC) has launched a new, interactive and consumer-friendly Web site — HomeSafetyCouncil.org — and is debuting results of a national survey that reveal the root of the home accident problem.

Parents and caregivers need to take greater action in order to reduce the nearly 20,000 deaths and 21 million medical visits that result from home injuries on average each year. The Home Safety Council’s annual Hands on Home Safety campaign calls on families to take steps to prevent the leading causes of accidental home injury: falls, poisoning, fires/burns, drowning, and choking/suffocation. The new Web site offers simple and easy tips caregivers can follow to keep loved ones of all ages safe at home.

“Our research shows that most parents and other caregivers lack the basic information they need to make their homes safer for themselves and their loved ones,” said Meri-K Appy, Home Safety Council president. “So, we designed our new Web site to bridge that gap, using targeted information for all stages of life. This helps caregivers hone in on the dangers most relevant to their own families. And, we break home safety into simple, illustrated and easy-to-understand steps so everyone can understand what to do to reduce injury risks.”

Prevent Poisoning

Poisoning is the second leading cause of home injury, yet 40 percent of parents surveyed report that they do not store medications in high cabinets that are secured with safety locks. And only half of the parents surveyed have installed a carbon monoxide detector to protect against the invisible and deadly gas.

The Home Safety Council recommends the following steps to protect against poisonings:

• Read the warning label before using potentially poisonous products.
• If you see the words “Caution”, “Warning”, “Danger”, “Poison” or “Keep Out of Reach of Children”, lock these items in a place where children can’t reach them.
• Use medications carefully. Follow the directions.
• Install carbon monoxide detectors near sleeping areas.
• Call the Poison Control Center at 1-800-222-1222 if you need help or want information about poisons.
• Call 9-1-1 if someone needs to go to the hospital right away.

From the PR Newswire, http://www.prnewswire.com/cgi-bin/stories.pl?ACCT=109&STORY=/www/story/05-20-2009/0005030220&EDATE:

Service That Saves California $70 Million In Health Care Costs And Prevents 164,000 Emergency Room Visits Annually To Close September 2009

SAN FRANCISCO, May 20 /PRNewswire-USNewswire/ — Funding for poison control services has been completely eliminated from the California state budget. Beginning in September of 2009, California will become the only state in the nation without any emergency poison control services for residents or medical professionals.

The California Poison Control System (CPCS) manages over 300,000 cases annually - that’s 900 every day. The elimination of poison control services will precipitate an immediate shift to more costly and already overburdened sectors of California’s healthcare system as residents have no choice but to go directly to an Emergency Department or call 911. However, the health professionals in California’s Emergency Departments, hospitals, and 911 services who rely on the CPCS to manage serious poison exposures will not have anywhere to turn for such expert advice.

The CPCS saves California millions of dollars. In 2008, managing cases through CPCS telephone consultation saved $70 million in health care costs. Eliminating the service would result in an additional 164,000 emergency room visits, either directly or by ambulance, every year.

This is a service Californians cannot afford to lose on the eve of additional cuts to health care. In this climate of economic uncertainty, the poison control center may be the only immediate and free expert medical service many residents can access.

“More than 50 percent of poisonings happen to children 5 years old and under and more than 90 percent happen at home,” said Stuart Heard, Executive Director of the California Poison Control System. “Without the services that we provide, California’s children will be at risk. This is why we are urging residents to pick up the phone and call the Governor’s office and their legislators to ask that the funding for the California Poison Control System be returned to the budget.”By calling the Office of the Governor at 916-445-2841 and their local Assembly or Senate member, which can be found by visiting www.leginfo.ca.gov/yourleg.html, Californians can demand that funding for poison control services be immediately reinstated.

Since its inception in 1997, the CPCS has managed over 2,000,000 cases. Clinical pharmacists, registered nurses, physicians and poison information providers answer the phones. A board-certified physician toxicologist is available at all times for specialized consultations from medical facilities seeking expert, current information in managing poison exposures.

In addition to providing access to poison experts, the CPCS is a central communication system infrastructure that can handle thousands of calls a day, providing real-time surveillance and identification of critical public health threats and rapid, reliable help during major public health events.

The CPCS has four sites of operation including UC Davis Medical Center in Sacramento, San Francisco General Hospital in San Francisco, Children’s Hospital Central California in Fresno and the UC San Diego Medical Center in San Diego. The central office is located at the UC San Francisco Laurel Heights Campus in San Francisco. The CPCS is responsible to the California Emergency Medical Services Authority and administered by the University of California San Francisco School of Pharmacy, Department of Clinical Pharmacy.

Read what the CPSC has to say about National Poison Prevention Week.

WASHINGTON, D.C. - Each year, unintentional poisonings from consumer products commonly found in the home kill about 30 children and prompt more than 2 million calls to the nation’s poison control centers. More than 90% of these calls involve poisonings in the home. On average, each year an estimated 80,000 children are treated in hospital emergency departments for unintentional poisonings.

This year’s 48th observance of National Poison Prevention Week, which is March 15-21, aims to help prevent those childhood poisonings. As one of the longest running public health campaigns, National Poison Prevention Week has contributed to the more than 80% reduction in the number of deaths related to poisonings (down from 216 in 1972). While there has been a significant decrease in deaths, studies show that unintentional child poisonings still remain a serious concern.

Children younger than age 5 account for the majority of the non-fatal poisonings. A recent review conducted by U.S. Consumer Product Safety Commission staff found that 70% of poisonings involve children 1 to 2 years of age. Oral prescription drugs, non prescription drugs and supplements were involved in more than half of the incidents.

“Awareness and action are the keys to preventing unintentional poisonings,” said CPSC Acting Chairman Nancy Nord. “Children act fast. So do poisons. That’s why we urge parents, grandparents and caregivers to have layers of poison prevention protection in the home.”

CPSC recommends that parents and caregivers immediately take these three steps. First, keep medicines and household chemicals in their original, child-resistant containers. Second, store the potentially hazardous substances up and out of a child’s sight and reach. And lastly, keep the National toll-free poison control center telephone number, 800-222-1222, handy in case of a poison emergency.

Additional poison prevention tips to check during National Poison Prevention Week:

• When hazardous products are in use, never let young children out of your sight, even if you must take them along when answering the phone or doorbell.
• Keep items closed and in their original containers.
• Leave the original labels on all products, and read the label before using.
• Always leave the light on when giving or taking medicine so that you can see what you are taking. Check the dosage every time.
• Avoid taking medicine in front of children. Refer to medicine as “medicine,” not “candy.”
• Clean out the medicine cabinet periodically and safely dispose of unneeded and outdated medicines.
• Do not put decorative lamps and candles that contain lamp oil where children can reach them. Lamp oil can be very toxic if ingested by young children.

We recently received some correspondence from Michael Fleming at www.acahoy.com to alert us of some lockable storage products they carry on their website.

 Information from their website:

Aca Hoy’s first line of products revolve around prescription pill safety and storage. Abuse of prescribed medicine is growing at an alarming rate. It is currently the second most drug used by teens and the most accessible to children. Prescription medicine has helped reduce pain and for some, assisted in daily living. It is time for all people to start taking responsibility for them by keeping them out of the hands of people they were not prescribed to. Drug stores keep them locked up and so should you.
Locking prescription pills could save the life of a child. Maybe even your own.

Email any questions or new product ideas: michael@acahoy.com.

If you happen to try out their products or know someone who has and can provide us with some feedback about them, we would greatly appreciate it.

If it’s made for the eyes it’s got to be safe right.

Sometimes not. When it comes to safe guarding your child, eyedrops need to be treated just like any other medication. If your child is exposed to any medication, call your local poison control center, 1-800-222-1222, immediately.

Glaucoma can effect people of all ages although the elderly are at higher risk. Glaucoma is the leading cause of visual impairment. A commonly prescribed eyedrop called brimonidine could cause serious harm and lead to admission to the hospital if a child were to be accidentally exposed.

A recent article, authored by Drs. Becker, Huntington and Woolf from Cambridge Hospital, Harvard Medical School and Children’s Hospital Boston, was published in Pediatrics, Official Journal of The American Academy of Pediatrics. They looked at brimonidine exposures in children < 6 years old. The data comes from the American Association of Poison Control Centers, 1997 to 2005 and is provided by the 61 member centers.

Of the 176 cases of unintentional brimonidine poisoning, 28 had to be hospitalized for treatment. The most common symptom reported was drowsiness. Less frequently reported but potentially more serious symptoms included included pallor, irritability, low blood pressure, breathing difficulties and prolonged slowing of the heart rate.

Please continue to keep all medications inaccessible to your child.

More details of the study can be found here: http://www.health.am/ab/more/glaucoma-eye-drops-can-harm-kids/.

The published article can be found here: http://pediatrics.aappublications.org/cgi/content/full/123/2/e305.