Victorian Poisons Information Centre Research Articles

Has the rescheduling of modified-release paracetamol in Australia affected the frequency of overdoses?

In June 2020, modified-release paracetamol (paracetamol-MR) preparations were up-scheduled from schedule-2 (available in pharmacy) to schedule-3 (available by request to a pharmacist only). The present study aims to ascertain whether up-scheduling affected the frequency of paracetamol-MR overdoses. This is a retrospective cohort study of two data sets from 1 June 2017 to 31 May 2022. Monash Health data were extracted using the diagnosis of paracetamol overdose coding and electronic medical records data. Calls regarding paracetamol-MR overdoses to Victorian Poisons Information Centre (VPIC) were extracted from the Poisons centre call database. We used a quasi-experimental research design with interrupted time series analysis to evaluate the immediate impact and change in trend of poisoning-related calls and ED presentations before and after June 2020. The change in proportion of paracetamol-MR cases in both databases was analysed using the Χ2 test. The proportion of paracetamol-MR cases in both data sets did not change. From Monash Health, there was no level change in monthly paracetamol-MR overdose-related presentations following re-scheduling (rate ratio [RR] = 1.08, 95% confidence interval [CI] = 0.57-2.01). There was no change in monthly paracetamol-MR overdose-related calls to VPIC following re-scheduling (RR = 1.05, 95% CI = 0.96-1.14). The proportion of paracetamol-MR overdoses did not decrease after the up-scheduling to S3. Similarly, the frequency of overdoses by month remained similar. Further limitations on access to paracetamol products may need to be considered.

Thirteen toxicology tidbits for the emergency clinician.

Emergency Medicine AustralasiaEarly View Trainee Focus Thirteen toxicology tidbits for the emergency clinician Zeff Koutsogiannis MBBS, FACEM, Zeff Koutsogiannis MBBS, FACEM GCertClinTox, Emergency Physician, Clinical Toxicologist Emergency Department, Austin Health, Melbourne, Victoria, Australia Victorian Poisons Information Centre, Austin Health, Melbourne, Victoria, AustraliaSearch for more papers by this authorMarina Guertin MBBS, MPH, DTM&H, Corresponding Author Marina Guertin MBBS, MPH, DTM&H DRANZCOG, Emergency Senior Registrar marina.guertin@gmail.com Emergency Department, Austin Health, Melbourne, Victoria, Australia Correspondence: Dr Marina Guertin, Emergency Department, Austin Health, 145 Studley Road, Heidelberg, VIC 3084, Australia. Email: marina.guertin@gmail.comSearch for more papers by this author Zeff Koutsogiannis MBBS, FACEM, Zeff Koutsogiannis MBBS, FACEM GCertClinTox, Emergency Physician, Clinical Toxicologist Emergency Department, Austin Health, Melbourne, Victoria, Australia Victorian Poisons Information Centre, Austin Health, Melbourne, Victoria, AustraliaSearch for more papers by this authorMarina Guertin MBBS, MPH, DTM&H, Corresponding Author Marina Guertin MBBS, MPH, DTM&H DRANZCOG, Emergency Senior Registrar marina.guertin@gmail.com Emergency Department, Austin Health, Melbourne, Victoria, Australia Correspondence: Dr Marina Guertin, Emergency Department, Austin Health, 145 Studley Road, Heidelberg, VIC 3084, Australia. Email: marina.guertin@gmail.comSearch for more papers by this author First published: 22 February 2023 https://doi.org/10.1111/1742-6723.14190Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinkedInRedditWechat No abstract is available for this article. Early ViewOnline Version of Record before inclusion in an issue RelatedInformation

A comparison of the accuracy of mushroom identification applications using digital photographs

Objective To compare the accuracy of three popular mushroom identification software applications in identifying mushrooms involved in exposures reported to the Victorian Poisons Information Centre and Royal Botanic Gardens Victoria. Background Over the past 10 years, an increasing number of software applications have been developed for use on smart phones and tablet devices to identify mushrooms. We have observed an increase in poisonings after incorrect identification of poisonous species as edible, using these applications. Design We compared the accuracy of three iPhone™ and Android™ mushroom identification applications: Picture Mushroom (Next Vision Limited©), Mushroom Identificator (Pierre Semedard©), and iNaturalist (iNaturalist, California Academy of Sciences©). Each app was tested independently by three researchers using digital photographs of 78 specimens sent to the Victorian Poisons Information Centre and Royal Botanic Gardens Victoria over a two-year period, 2020–2021. Mushroom identification was confirmed by an expert mycologist. For each app, individual and combined results were compared. Results Picture Mushroom was the most accurate of the three apps and correctly identified 49% (95% CI [0–100]) of specimens, compared with Mushroom Identificator (35% [15–56]) and iNaturalist (35% [0–76]). Picture Mushroom correctly identified 44% of poisonous mushrooms [0–95], compared with Mushroom Identificator (30% [1–58]) and iNaturalist (40% [0–84), but Mushroom Identificator identified more specimens of Amanita phalloides correctly (67%), compared to Picture Mushroom (60%) and iNaturalist (27%). Amanita phalloides was falsely identified, twice by Picture Mushroom and once by iNaturalist. Conclusions Mushroom identification applications may be useful future tools to assist clinical toxicologists and the general public in the accurate identification of mushrooms species but, at present, are not reliable enough to exclude exposure to potentially poisonous mushrooms when used alone.

Trends in calls to a state poisons centre and presentation to emergency departments for intentional antidepressant overdose in Victoria, Australia.

To describe the rates and trends of emergency department presentations and calls to a state poisons centre for antidepressant overdose. A retrospective cohort study utilising the Victorian Emergency Minimum Dataset and Victorian Poisons Information Centre call registry between January 2009 and December 2018 was conducted. This captured all presentations to Victorian emergency departments and calls to the Victorian Poisons Information Centre. Any intentional overdose involving an antidepressant was included. Annual rates of emergency department presentations and calls per 100,000 persons and 100,000 prescriptions for antidepressants overall and individual antidepressant classes, in addition to age-group-specific rates, were reported. A total of 3650 presentations to emergency department and 7096 calls to the poisons centre were included. No changes were seen in overall emergency department presentation rates when controlled for population or prescription numbers, but large and significant increases were seen for younger age groups. The 10-14- and 15-19-year age groups had average annual increases of 13.1% (95% CI = [6.5%, 19.7%], p < 0.001) and 7.2% (95% CI = [2.8%, 11.5%], p < 0.001) per 100,000 persons, respectively. Increases were seen in overall annual call rates of 6.7% (95% CI = [5.2%, 8.1%], p < 0.001) per 100,000 persons and 7.5% (95% CI = [4.9%, 10.1%], p < 0.001) per 100,000 prescriptions. Overall, emergency department presentation rates remained stable during the study period. Overall poisons centre call rates increased moderately. However, when examining younger persons, large increases were seen in both emergency department presentations and poison centre call rates. These findings highlight the need for future interventions to mitigate against intentional overdose in younger populations.

Exposure to hand sanitisers and other cleaning products in Victoria, Australia during the COVID-19 pandemic

Background In response to the COVID-19 pandemic, there was increased promotion and use of topical antiseptics (especially hand sanitisers) and cleaning products to reduce transmission of the SARS-CoV-2 virus. This study describes unintentional exposures (oral or ocular) to these substances by children during the first year (2020) of the COVID-19 pandemic compared to the previous year (2019). Methods This was a retrospective observational study of unintentional exposures reported to the Victorian Poisons Information Centre for the period 1 January 2019 to 31 December 2020. Substances included topical antiseptics (including hand sanitisers), bleach, multipurpose cleaners, disinfectants and high-percentage ethanol products. We analysed data for two age groups; under 5 years and 5 to 14 years. Results Oral exposures (ingestion or buccal) to topical antiseptics increased from 435 in 2019 to 882 in 2020 in the under 5 age group, with peak call numbers in 2020 coinciding with peaks in active COVID-19 daily case numbers. Oral exposures in older children (5–14 years) were lower (23 and 77 in 2019 and 2020, respectively). No children had moderate or severe symptoms at the time of the call to the Poisons Centre. Ocular exposures to topical antiseptics more than doubled from 2019 to 2020 (from 20 to 53 among children under 5 years, and 8 to 18 in older children). The majority of children with ocular exposure presented with mild symptoms; one had moderate symptoms. Changes in exposures to disinfectants, bleach and cleaners were smaller and not consistent with peaks in active COVID-19 cases. Conclusions Unintentional oral exposures to topical disinfectants (mainly hand sanitiser) by young children increased during the COVID-19 pandemic and were more prevalent during periods of increased COVID-19 cases. While there were no cases of severe harm identified, the high number of exposures suggests that appropriate use and storage of hand sanitisers should be promoted.

Iatrogenic medication errors reported to the Victorian Poisons Information Centre.

Iatrogenic medication errors are a cause of medical morbidity and mortality. They result in significant cost to the Australian healthcare system each year. There is limited Australian evidence describing the iatrogenic errors occurring within the hospital system. To examine and describe iatrogenic medication errors occurring in Victorian healthcare settings through the analysis of referrals to a state Poisons Information Centre (PIC). A retrospective review of iatrogenic medication errors reported to the Victorian PIC (VPIC) from community and hospital healthcare settings from January 2015 to December 2019. Over a 5-year period, 357 iatrogenic errors were identified, 63% (n = 224) of which occurred in a hospital setting. The remaining errors occurred in a community healthcare setting. One in five patients were symptomatic from the medication error at the time of the call to the VPIC, and a change in management was required in 45% (n = 165) of all cases. Five percent (n = 17) of patients developed moderate to severe clinical toxicity as determined by the recorded poisoning severity score, and 88% (n = 18) of these required critical care management. Incorrect medication dosing accounted for 62% (n = 221) of errors. Common medication dosing errors included: double dose (51%, n = 114), incorrect medication administered (14%, n = 49), incorrect route (9%, n = 31), incorrect patient (6%, n = 22) and adult dose given to a child (4%, n = 15). Iatrogenic errors are occurring in the Victorian health care system. These errors can result in serious morbidity. Identification of causative factors and investment in preventative strategies will likely reduce associated morbidity and healthcare costs.

The impact of codeine upscheduling on overdoses, Emergency Department presentations and mortality in Victoria, Australia

Background and aimsPrior to February 2018, codeine was available over-the-counter (OTC) in Australia as a pharmacist-only medicine (Schedule 3) in low-strength formulations when in combination with simple analgesics. In February 2018, The Advisory Committee on Medicines Scheduling (ACMS) upscheduled codeine-containing medicines (CCM) to Schedule 4 (prescription-only medicine). This study aimed to determine the impact of upscheduling on prescriptions, overdoses and deaths. MethodsThis study used interrupted time series analysis, a quasi-experimental design, to retrospectively evaluate the impact of upscheduling on overdose poisoning calls to the Victorian Poisons Information Centre (VPIC), Emergency Department (ED) presentations to Austin Health, and deaths reported to the Victorian Coroner from 1 January 2013–31 December 2019. ResultsThere was a significant reduction in the trend of high-strength codeine poisoning calls by 0.36 (P = 0.03, 95 % CI = [−0.69, −0.04]). Low-strength codeine poisoning calls to the VPIC reduced by 13.31 (P <0.001, 95 % CI = [−16.80, 9.82]]) calls in February 2018, followed by continued reduction of 0.12 calls per month. High-strength codeine overdose ED presentations reduced in the first quarter of 2018 by 3.72 presentations (P = 0.004, 95 % CI = [−6.13, −1.31]). Low-strength codeine overdose ED presentations after the first quarter of 2018 by 0.33 (P = 0.03, 95 % CI = [−0.63, −0.03]) presentations per month. Codeine-related deaths reduced by 7.19 (P < 0.001, 95 % CI = [−9.44, −4.94]) deaths in February 2018. ConclusionsCodeine upscheduling to prescription-only medicine has reduced codeine-related poisoning calls, overdoses and unnatural death in Victoria.

Increasing rates of quetiapine overdose, misuse, and mortality in Victoria, Australia

BackgroundQuetiapine is misused due to its anxiolytic and hedonic effects and has been associated with deliberate self-harm. This study analyzed quetiapine-related calls to the Victorian Poisons Information Centre (VPIC), coronial data from Victorian Institute of Forensic Medicine (VIFM) and prescribed data from the Pharmaceutical Benefits Scheme (PBS) to determine current trends in overdose, misuse and mortality. MethodsThis was a retrospective review of multiple databases. Calls to VPIC and coronial data from the VIFM were reviewed from 2006 to 2016. PBS prescription data from 2000 to 2015 was obtained from the Australian Statistics on Medicines website. ResultsVPIC data indicated a 6-fold increase in the number of quetiapine-related calls over the 11-year period of which most were overdose-related (77%). Overdose and misuse calls increased by 6-fold and 6.6-fold, respectively. Coronial data also indicated a rise in quetiapine-related harm; a 7.4-fold increase in quetiapine-related deaths was recorded for the same period. Similarly, Australian PBS data showed that quetiapine prescriptions increased 285-fold since 2000. There was a significant positive correlation between the increase in prescribing and overdose (r = 0.75, p < 0.001), and prescribing and mortality (r = 0.82, p < 0.01). ConclusionsThis study revealed an increasing trend of misuse, non-fatal and fatal overdoses in Victoria over the last decade. The increasing rates of prescriptions in Australia and thus increased quetiapine availability are likely to have contributed to increased poisoning and mortality. Further research is warranted to explore the reasons behind increased prescribing, including off-label use.

Workplace chemical and toxin exposures reported to a Poisons Information Centre: a diverse range causing variable morbidity.

The aim of this study is to determine the period prevalence, nature and causes of workplace chemical and toxin exposures reported to the Victorian Poisons Information Centre (VPIC). All cases classified as 'workplace: acute' when entered into the VPIC database (June 2005-December 2013) were analysed. Data were collected on patient sex, the nature of the chemical or toxin, route of exposure and season. Overall, 4928 cases were extracted. Exposures to men (71.5% of calls) differed from women (P<0.001), with most exposures relating to industry/trade substances (23.7%) and cleaners/bleaches/detergents (36.9%), respectively. Ocular (33.2%), inhalational (27.7%) and dermal (22.1%) exposures were most common. Exposures were most common in Spring and most seasonal variation was found for veterinary/animal, agricultural/plant and household categories (P<0.05). In all, 3445 (69.9%) cases had symptoms related to their exposure at the time of the call. However, the proportion of symptomatic cases within the major substance categories differed significantly (P<0.001). Chemicals associated with the most symptoms were cleaners/bleaches/detergents, industrial/trade substances and acids. Mild-moderately important workplace exposures are common. Significant variations exist between the sexes and seasons. Poisons Information Centres may play a role in ongoing surveillance of chemical and toxin exposures and a minimum exposure dataset is recommended.

Agomelatine overdose and related toxicity

Agomelatine is a melatonin receptor agonist (MT1 and MT2) and 5-HT2c receptor antagonist. It is used as an antidepressant. There is limited information regarding agomelatine toxicity in overdose. This study analyzed calls to the Victorian Poisons Information Centre (VPIC) to further define agomelatine toxicity in poisoned patients. This was a retrospective review of calls to VPIC from May 2011 to May 2018. The VPIC database was interrogated for the terms “agomelatine”, “Valdoxan®” and “antidepressant” and call records extracted. Calls not related to agomelatine exposure were excluded. Patient demographics, reported symptoms, ingested dose, poisoning severity scores and intent were analyzed. There were 99 agomelatine-related calls during the study period. Most calls were related to intentional overdose (n = 72, 72.7%). The majority of these were polydrug overdoses (n = 56, 77.8%). There were 16 (22%) cases of sole agomelatine overdose and most patients reported to be asymptomatic (60%, n = 9). Other patients developed drowsiness (31.3%), dizziness (6.3%) or nausea (6.3%) at a median of 1.63 h (IQR 0.46, 4.25) post ingestion. Findings suggest that sole agomelatine ingestion can result in drowsiness, dizziness, or nausea. More severe toxicity has been reported with polydrug overdose.

Paracetamol toxicity: What would be the implications of a change in Australian treatment guidelines?

The present study aims to study the implications for resource utilisation if Australia adopted recent revised UK treatment guidelines for paracetamol poisoning. Retrospective database review of paracetamol toxicity presentations and calls from the Victorian Poisons Information Centre (VPIC) and Austin Hospital, Victoria, Australia, from 1 January 2010 to 31 December 2011. There were 200 presentations at the Austin Hospital, and the VPIC received 4272 calls regarding paracetamol toxicity. An analytical model was designed to estimate the cost of this additional treatment and referral to hospital. The main outcome measures were the potential increase in number of admissions requiring treatment with N-acetylcysteine (NAC), costs involved and increased number of referrals to hospitals by the VPIC. Twenty-five (12.5%, 95% confidence interval 8.4-17.6%, P < 0.01) patients in our study who did not qualify for NAC therapy based upon the current Australasian paracetamol treatment guideline would have received it if the revised UK guideline was followed. Eighteen (72%) of these presented with acute single ingestions of paracetamol. No patients re-presented to our hospital with acute liver injury or required admission to the liver transplant unit. Alignment of current Australian paracetamol treatment guidelines with those in the UK would result in an increase in ED attendances as directed by Poisons Information Centres and hospital admissions for antidotal treatment. This would be associated with increased health expenditure and inpatient bed utilisation. The present study does not support the clinical need for adoption of UK paracetamol treatment guidelines in Australia.

The epidemiology of chemical eye exposures reported to the Victorian Poisons Information Centre

We aimed to determine the epidemiology of chemical eye exposures reported to the Victorian Poisons Information Centre, Australia. This was a prospective case series comprising consecutive calls to the Victorian Poisons Information Centre that related to chemical eye exposures (January 2009-2010). Data included patient demographics, place and cause of exposure, nature of the chemical, symptoms and advice given. Patients were telephoned 48 h later to determine the outcome and whether the advice had been taken. One thousand four hundred and eighty patients were enroled (45.7%, aged <16 years) with 937 (63.3%) followed up. Cleaning agents (32.6%), topical personal products (25.4%), industrial agents (11.8%), herbicides/pesticides (5.7%), petroleum products (4.2%) and miscellaneous agents (20.3%) comprised the exposure groups. Men were exposed to significantly more industrial agents (74.8 vs. 25.2%) and fewer topical personal agents (31.3 vs. 68.7%) than women, (P<0.001). Children were exposed to significantly more topical personal agents (65.2 vs. 34.8%) and fewer industrial agents (28.7 vs. 71.3%) than adults (P<0.001). The median time between exposure and the call for advice was significantly shorter for children (P<0.001). Eight hundred and ten (54.7%) patients were advised that medical care was not required. The remainder were advised to seek care or were already receiving care. At follow-up, only 63 (6.7%) patients were symptomatic. Eight hundred and fifty patients (90.8%) had complied with the advice given. There were no compliance differences between men/women and children/adults (P>0.05). Most exposures are of little consequence. However, there are clear epidemiological differences between sex and age groups. These findings will help inform prevention strategies.

Hydrofluoric acid poisoning: Data from the Victorian Poisons Information Centre

To determine the epidemiology of hydrofluoric acid (HF) exposures, over an extended time period, in Victoria, Australia. Retrospective case review of all HF exposures from calls to the Victorian Poisons Information Centre (VPIC) from June 2005 to February 2011. The VPIC received calls regarding 75 separate HF exposures (approximately 12 per year). The majority 68 (91%) of calls related to male patients. Sixty-nine (92%) calls related to adults, six (8%) to children (<12 years) and none to the elderly (>65 years age). Fifty-three per cent of exposures occurred at the workplace. Dermal exposures comprised 54 (72%). Forty-six (85%) of these resulted from hand contact, six (11%) arm and two (4%) legs. The second most common exposure was ocular 11 (15%). More than half of exposures involved HF concentrations of 10% or less. Of the dermal exposures treated in EDs, 16% required calcium treatment in a form other than gel. Overall poisoning severity was mild (79% of cases Poisoning Severity Score of 0 or 1). Health professionals were the most frequent callers (53% of all cases). Calls to the VPIC regarding HF are relatively rare, but almost all calls regarding HF taken by the VPIC required hospital evaluation. The majority of exposures were accidental occupational dermal exposures in male adults and most of these were minor, requiring topical calcium gel only. Small exposures with higher concentrated HF can be fatal; however, there were no cases of severe toxicity in the present study.

Changing Epidemiology of Intentional Antidepressant Drug Overdose in Victoria, Australia

To determine the epidemiology of intentional antidepressant drug overdose (OD), over an extended time period, in Victoria, Australia. Retrospective epidemiological study of all cases reported to the Victorian Emergency Minimum Dataset (VEMD) January 1998 to December 2007 and calls to the Victorian Poisons Information Centre (VPIC) June 2005 to September 2008. 5467 VEMD cases were analysed. 3169 (57.9%) cases involved selective serotonin reuptake inhibitors (SSRIs) and 1149 (21%) involved tricyclic antidepressants (TCAs). Sertraline (1252, 22.9% cases) was the most common drug. During 2001, the peak year of OD, there were 8.8 OD/100 000 population in the SSRI group and 3.8 OD/100 000 population in the TCA group. Trends over the study period showed increasing SSRI and 'other' newer antidepressant prescription rates and decreases for TCA and monoamine oxidase inhibitors (MAOI). However, the risks of OD in all drug classes were similar and OD/100 000 prescriptions trended downwards for all drug classes over time. 1833 VPIC calls were analysed. Calls relating to SSRIs were the most common yet SSRI OD was associated with significantly fewer symptoms (p < 0.001) and fewer patients with Poisoning Severity Score classifications of moderate or severe (p < 0.01). Antidepressant OD patterns are changing. Antidepressant OD incidence is following prescribing trends. The risk of OD is similar for all drug classes. Absolute numbers of OD and OD/100 000 prescriptions are decreasing for all drug classes.

Therapeutic errors involving adults in the community setting: nature, causes and outcomes

To compare the nature of therapeutic errors made by adults in community residential units (CRU) and private homes (Home). This was an analytical case series of therapeutic errors, involving adults, reported to the Victorian Poisons Information Centre (January 2006 to March 2007). The main outcome measures were the nature, causes and outcomes of the errors and actions taken or recommendations for avoidance. Ninety-seven CRU and 611 Home residents (cases) were enrolled. These groups took 243 (median 2) and 785 (median 1) medications in error, respectively (p<0.001). The medication administrators were predominately staff members (94.8%) and the cases themselves (95.9%), respectively (p<0.001). The CRU cases more frequently had an incorrect medication(s) or another person's medication(s) and the Home cases a double dose or incorrect dose (p<0.001). Wide ranges of medications were taken in error with cardiac and respiratory medications being more common among the Home cases. Four (4.1%, 95% CI 1.3-10.8) CRU and 16 (2.6%, 95% CI 1.6-4.3) Home cases were referred to hospital. No case followed up had a serious outcome. Error cause differed significantly between the groups (p<0.001). Staffing issues and human factors were common within the CRU and Home groups, respectively. Therapeutic errors in the community are preventable and differ considerably between the CRU and Home settings. Prevention initiatives are indicated with particular attention to CRU staffing, training and procedural issues.

Therapeutic errors among children in the community setting: nature, causes and outcomes

This study aimed to determine the epidemiology of therapeutic errors among children in the community setting. This was a prospective, observational study of 491 consecutive cases reported to the Victorian Poisons Information Centre, between January 2006 and March 2007. A total of 450 (91.7%) parents/carers were followed up by telephone approximately 48 h after the initial call. The main outcome measures were the nature, causes and outcomes of the errors and actions taken or recommendations given to avoid future errors. The majority of children (334, 68.0%, 95% confidence interval (CI) 63.7, 72.1) were aged <or=3 years. Incorrect and double dosage accounted for 279 (56.8%, 95% CI 52.3, 61.2) and 128 (26.1%, 95% CI 22.3, 30.2) cases, respectively. Almost all errors occurred in the home (98.2%) and involved a single medication (98.8%) and the oral route (98.4%). Close family members were responsible in 408 (83.1%, 95% CI 79.4, 86.2) cases. Analgesics and cough and cold preparations were taken in error in 259 (52.0%) cases. Human (rushing, distraction, carelessness) and communication factors were reported to be causal factors in 337 (38.4%, 95% CI 35.2, 41.8) and 111 (12.7%, 95% CI 10.6, 15.1) cases, respectively. In almost all cases (474, 96.5%, 95% CI 94.4, 97.9), the caller was advised to observe the child at home, and no child experienced significant morbidity. Preventive strategies included attention to administration care and routine, communication, medication storage, administration devices, packaging and labelling issues. Very young children are at particular risk, especially from single, over-the-counter medication dosing errors, made at home by family members.

Therapeutic Errors reported to the Victorian Poisons Information Centre—Pilot Study

ABSTRACTAimTo analyse a sample of therapeutic errors reported to the Victorian Poisons Information Centre.MethodA retrospective series of 102 cases of therapeutic error reported in March 2005 were examined. Data were extracted from the Victorian Poisons Information Centre database.ResultsOf the 102 cases of therapeutic error, females (64%) and adults (72%) predominated. Most errors (91%) occurred in patients' homes. 87 (85%) cases did not require medical attention. In 68 (67%) cases, the subject made the error and in almost all (93%) cases the error involved oral drug administration. Most (84%) subjects were asymptomatic at the time of the call. In total, 125 drugs were taken in error and 11 (11%) subjects made multiple errors. The predominant drug classes were analgesics, anti‐inflammatory drugs, cardiac drugs, antipsychotics and antidepressants. An incorrect dose was taken in 47 (46%) cases and drugs were taken too early in 12 (12%) cases. An incorrect administration route was used in 9 (9%) cases. Incorrect labelling, formulating and packaging accounted for 4 (4%) errors.ConclusionAlthough most errors reported during the study were unlikely to cause harm, a large prospective study is indicated to clarify error patterns and inform prevention strategies.

Medicinal Mishap: Dosing errors with Donnalix Infant Drops

Parents of a three-month-old boy, weighing 5 kg, phoned the Victorian Poisons Information Centre for advice. The...

Unintentional ingestion of over the counter medications in children less than 5 years old.

Childhood ingestion of medications remains a substantial problem. Medication available over the counter (OTC) is widely used and has significant toxicity. The present study aims to investigate the nature and extent of unintentional ingestion of OTC medication in children < 5 years old in Victoria, Australia, during the period 1996-2000, in order to highlight critical factors. Numbers of enquiries relating to unintentional ingestion of OTC medication in children < 5 years old and medication types were obtained from the Victorian Poisons Information Centre for 1998-2000. Emergency Department presentations involving poisoning of children < 5 years old, the medication types and subsequent admissions were obtained from the Victorian Emergency Minimum Dataset for 1996-2000. Numbers of enquiries and Emergency Department attendances for poisoning were substantially higher for OTC medication than for prescription medication; however, a lower proportion of cases involving ingestion of OTC medication (24.8%) required hospital admission during the study period compared with cases involving ingestion of prescription medications (33.8%). Overall, the peak incidence was at 2 years of age, with a slight male over-representation. Paracetamol and cough/cold preparations were the most common agents. The causes of unintentional ingestion of OTC medications by children might include lack of child-resistant closure (CRC), inadequate design of CRC, attitudes concerning the toxicity of OTC medications, or lack of vigilance by parents and carers in the storage and administration of OTC medications. Consideration should be given to restricting sales of toxic OTC medications to pharmacies, and increasing counselling of consumers concerning the toxicity and safe storage of OTC medications and the correct usage of CRC. The adequacy of CRC design and OTC medications warranting CRC should be reviewed by the relevant authorities.

Victorian Poisons Information Centre‐25 Years in the Royal Children's Hospital Pharmacy Department

The Victorian Poisons Information Centre has been based in the Pharmacy Department at the Royal Children's Hospital in Melbourne for 25 years. This article outlines changes in childhood poisoning and service development, and challenges for the future. Mortality from childhood poisoning has decreased with most serious poisonings now involving medicines. Inducing emesis is no longer recommended in the treatment of poisoning. Information sources are now CD‐ROM and Internet based. The Centre has developed a web site to allow users an alternative means of access. A national telephone number for poisons information centres has facilitated inclusion of the number on product labels and advertising of the service. Challenges for the future include developing a relationship with clinical toxicologists, ensuring users understand the benefits of ringing the Centre rather than accessing information on the Internet, enhancing interaction between Australian poisons information centres, and undertaking relevant research.