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Article ; Online: A retrospective analysis of therapeutic drug exposures in New Zealand National Poisons Centre data 2018-2020.

Kumpula, Eeva-Katri / Paterson, Daniel A / Pomerleau, Adam C

Australian and New Zealand journal of public health

2023 Volume 47, Issue 2, Page(s) 100027

Abstract: Objective: The New Zealand National Poisons Centre advises the general public and health professionals on management of exposures to various substances. The epidemiology of medicine exposures was used to characterise inappropriate use of medicines ... ...

Abstract	Objective: The New Zealand National Poisons Centre advises the general public and health professionals on management of exposures to various substances. The epidemiology of medicine exposures was used to characterise inappropriate use of medicines across age groups. Methods: Data from contacts in 2018-2020 were analysed: patient demographics (age, gender), number of therapeutic substances, and advice given. The most frequent individual therapeutic substance exposures across age groups and the reasons for these occurring were determined. Results: A total of 76% of children's (aged 0-12 or unknown child) exposures were exploratory in nature, involving a variety of medicines. Youth (aged 13-19) had frequently engaged in intentional self-poisoning (61% of their exposures), and most commonly by exposure to paracetamol, antidepressants, and quetiapine. Adults (aged 20-64) and older adults (aged 65 and over) were frequently affected by therapeutic errors (50% and 86% of their exposures, respectively). Adults were most frequently exposed to paracetamol, codeine, tramadol, antidepressants, and hypnotics, while older adults were exposed to paracetamol and various cardiac medications. Conclusions: Types of inappropriate medicine exposures vary in different age groups. Implications for public health: Poisons centre data add to pharmacovigilance monitoring of potential harm from medicines and inform medication safety policies and interventions.
MeSH term(s)	Child ; Adolescent ; Humans ; Aged ; Poisons ; Retrospective Studies ; Acetaminophen ; New Zealand/epidemiology ; Poison Control Centers ; Antidepressive Agents/adverse effects ; Poisoning/epidemiology
Chemical Substances	Poisons ; Acetaminophen (362O9ITL9D) ; Antidepressive Agents
Language	English
Publishing date	2023-03-10
Publishing country	United States
Document type	Journal Article
ZDB-ID	1323548-5
ISSN	1753-6405 ; 1326-0200
ISSN (online)	1753-6405
ISSN	1326-0200
DOI	10.1016/j.anzjph.2023.100027
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Article ; Online: Specialist medical toxicologist consultations provided by the New Zealand National Poisons Centre, 2018-2020.

Pomerleau, Adam C / Gee, Paul / Beasley, D Michael G / Kumpula, Eeva-Katri

The New Zealand medical journal

2023 Volume 136, Issue 1569, Page(s) 60–71

Abstract: Aims: The National Poisons Centre (NPC) provides 24/7 specialist medical toxicologist consultations to healthcare professionals regarding the clinical management of poisoning cases. The use of toxicologist services was investigated to characterise the ... ...

Abstract	Aims: The National Poisons Centre (NPC) provides 24/7 specialist medical toxicologist consultations to healthcare professionals regarding the clinical management of poisoning cases. The use of toxicologist services was investigated to characterise the extent and content of consults to inform further development of this service. Methods: A retrospective analysis of 2018-2020 medical toxicologist consultations summarised contact numbers, professional backgrounds and district health boards (DHBs) of the people contacting the NPC, and the patient(s) and substance(s) involved. Results: There were 3,451 medical toxicologist consultations with 2,400 (67%) provided directly to healthcare professionals. Crude rates of consults increased across all DHBs. Of all 2,603 therapeutic substances that were consulted about during the study period, 1,492 (57.3%) were drugs affecting the nervous system, and paracetamol was the most common individual drug (528; 20.3%). Of all 1,185 non-therapeutic substance exposures that were advised on, 66 (5.6%) were unidentified mushrooms, 51 (4.3%) unidentified substances, and 47 (4.0%) lead exposures. Conclusions: There was increasing utilisation of the NPC service by healthcare professionals from all 24 areas of the country, covering a wide range of substance exposures and scenarios. The growing utilisation suggests healthcare professionals derive value from this consultation service for the care of their patients.
MeSH term(s)	Humans ; New Zealand ; Poisons ; Referral and Consultation ; Retrospective Studies
Chemical Substances	Poisons
Language	English
Publishing date	2023-02-03
Publishing country	New Zealand
Document type	Journal Article
ZDB-ID	390590-1
ISSN	1175-8716 ; 0028-8446 ; 0110-7704
ISSN (online)	1175-8716
ISSN	0028-8446 ; 0110-7704
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Article ; Online: Modifying triage protocols for poisoned patients during the COVID-19 pandemic to contribute to preservation of healthcare capacity: early experience of the New Zealand National Poisons Centre.

Pomerleau, Adam C / Slaughter, Robin / Kumpula, Eeva-Katri

Clinical toxicology (Philadelphia, Pa.)

2021 Volume 59, Issue 8, Page(s) 760–761

MeSH term(s)	COVID-19/epidemiology ; Clinical Protocols ; Humans ; New Zealand ; Poison Control Centers ; Poisoning/therapy ; SARS-CoV-2 ; Triage
Language	English
Publishing date	2021-01-04
Publishing country	England
Document type	Letter
ZDB-ID	204476-6
ISSN	1556-9519 ; 0009-9309 ; 0731-3810 ; 1556-3650
ISSN (online)	1556-9519
ISSN	0009-9309 ; 0731-3810 ; 1556-3650
DOI	10.1080/15563650.2020.1864393
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Article ; Online: Naloxone use by Aotearoa New Zealand emergency medical services, 2017-2021.

Kumpula, Eeva-Katri / Todd, Verity F / O'Byrne, David / Dicker, Bridget L / Pomerleau, Adam C

Emergency medicine Australasia : EMA

2023

Abstract: Objective: Emergency medical services (EMS) use of naloxone in the prehospital setting is indicated in patients who have significantly impaired breathing or level of consciousness when opioid intoxication is suspected. The present study characterised ... ...

Abstract	Objective: Emergency medical services (EMS) use of naloxone in the prehospital setting is indicated in patients who have significantly impaired breathing or level of consciousness when opioid intoxication is suspected. The present study characterised naloxone use in a nationwide sample of Aotearoa New Zealand road EMS patients to establish a baseline for surveillance of any changes in the future. Methods: A retrospective analysis of rates of patients with naloxone administrations was conducted using Hato Hone St John (2017-2021) and Wellington Free Ambulance (2018-2021) electronic patient report form datasets. Patient demographics, presenting complaints, naloxone dosing, and initial and last vital sign clinical observations were described. Results: There were 2018 patients with an equal proportion of males and females, and patient median age was 47 years. There were between 8.0 (in 2018) and 9.0 (in 2020) naloxone administrations per 100 000 population-years, or approximately one administration per day for the whole country of 5 million people. Poisoning by unknown agent(s) was the most common presenting complaint (61%). The median dose of naloxone per patient was 0.4 mg; 85% was administered intravenously. The median observed change in Glasgow Coma Scale score was +1, and respiratory rate increased by +2 breaths/min. Conclusions: A national rate of EMS naloxone patients was established; measured clinical effects of naloxone were modest, suggesting many patients had reasons other than opioid toxicity contributing to their symptoms. Naloxone administration rates provide indirect surveillance information about suspected harmful opioid exposures but need to be interpreted with care.
Language	English
Publishing date	2023-11-30
Publishing country	Australia
Document type	Journal Article
ZDB-ID	2161824-0
ISSN	1742-6723 ; 1742-6731 ; 1035-6851
ISSN (online)	1742-6723
ISSN	1742-6731 ; 1035-6851
DOI	10.1111/1742-6723.14358
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Article ; Online: Enquiries to the New Zealand National Poisons Centre in 2018.

Kumpula, Eeva-Katri / Shieffelbien, Lucy M / Pomerleau, Adam C

Emergency medicine Australasia : EMA

2020 Volume 33, Issue 1, Page(s) 45–51

Abstract: Objective: A retrospective analysis of enquiries made to the New Zealand National Poisons Centre (NZNPC) in 2018; which includes direct contacts through telephone of caller, patient and exposure substance characteristics, and indirect contacts through ... ...

Abstract	Objective: A retrospective analysis of enquiries made to the New Zealand National Poisons Centre (NZNPC) in 2018; which includes direct contacts through telephone of caller, patient and exposure substance characteristics, and indirect contacts through the internet of page hits by New Zealand (NZ) healthcare professionals on the TOXINZ poisons information database. Methods: All calls made to the NZNPC, and TOXINZ page hits by NZ based healthcare professionals, from 1 January to 31 December 2018 were analysed. For calls, caller location and relationship to the patient, reason and site for the exposure, patient demographics and the management advice given by NZNPC were described. Substance classes and most frequently encountered individual agents were described for both call data and web page hits to TOXINZ. Results: There were 25 330 calls to the NZNPC and 39 028 TOXINZ web page hits in 2018. Most callers were members of the public (79.4%), calling from residential settings (77.2%), reporting an exposure which had occurred in a residential setting (88.2%) because of child exploratory behaviour (50.3%), and which involved a person aged 0-4 years (50.3%) who could be managed at home (74.3%). TOXINZ searches mostly involved therapeutics, especially paracetamol. Conclusions: In 2018, the NZNPC provided assessment and/or advice in 64 358 enquiries, comprising 25 330 direct contacts and 39 028 indirect contacts. The NZNPC provides specialised services regularly used by both members of the public and healthcare professionals that contributes to the clinical management of poisoned and potentially poisoned patients in NZ.
MeSH term(s)	Child ; Humans ; New Zealand ; Poison Control Centers ; Poisoning/epidemiology ; Poisoning/therapy ; Poisons ; Retrospective Studies ; Telephone
Chemical Substances	Poisons
Language	English
Publishing date	2020-06-19
Publishing country	Australia
Document type	Journal Article
ZDB-ID	2161824-0
ISSN	1742-6723 ; 1742-6731 ; 1035-6851
ISSN (online)	1742-6723
ISSN	1742-6731 ; 1035-6851
DOI	10.1111/1742-6723.13563
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Article ; Online: Stocks of paracetamol products stored in urban New Zealand households: A cross-sectional study.

Kumpula, Eeva-Katri / Norris, Pauline / Pomerleau, Adam C

PloS one

2020 Volume 15, Issue 6, Page(s) e0233806

Abstract: Background: Intentional self-harm is a common cause of hospital presentations in New Zealand and across the world, and self-poisoning is the most common method of self-harm. Paracetamol (acetaminophen) is frequently used in impulsive intentional ... ...

Abstract	Background: Intentional self-harm is a common cause of hospital presentations in New Zealand and across the world, and self-poisoning is the most common method of self-harm. Paracetamol (acetaminophen) is frequently used in impulsive intentional overdoses, where ease of access may determine the choice of substance. Objective: This cross-sectional study aimed to determine how much paracetamol is present and therefore accessible in urban New Zealand households, and sources from where it has been obtained. This information is not currently available through any other means, but could inform New Zealand drug policy on access to paracetamol. Methods: Random cluster-sampling of households was performed in major urban areas of two cities in New Zealand, and the paracetamol-containing products, quantities, and sources were recorded. Population estimates of proportions of various types of paracetamol products were calculated. Results: A total of 174 of the 201 study households (86.6%) had at least one paracetamol product. Study households had mostly prescription products (78.2% of total mass), and a median of 24.0 g paracetamol present per household (inter-quartile range 6.0-54.0 g). Prescribed paracetamol was the main source of large stock. Based on the study findings, 53% of New Zealand households had 30 g or more paracetamol present, and 36% had 30 g or more of prescribed paracetamol, specifically. Conclusions: This study highlights the importance of assessing whether and how much paracetamol is truly needed when prescribing and dispensing it. Convenience of appropriate access to therapeutic paracetamol needs to be balanced with preventing unnecessary accumulation of paracetamol stocks in households and inappropriate access to it. Prescribers and pharmacists need to be aware of the risks of such accumulation and assess the therapeutic needs of their patients. Public initiatives should be rolled out at regular intervals to encourage people to return unused or expired medicines to pharmacies for safe disposal.
MeSH term(s)	Acetaminophen/administration & dosage ; Acetaminophen/supply & distribution ; Adult ; Cities/statistics & numerical data ; Drug Storage ; Drug Utilization/statistics & numerical data ; Family Characteristics ; Female ; Humans ; Male ; New Zealand ; Prescription Drug Misuse/statistics & numerical data ; Self Administration
Chemical Substances	Acetaminophen (362O9ITL9D)
Language	English
Publishing date	2020-06-01
Publishing country	United States
Document type	Journal Article ; Research Support, Non-U.S. Gov't
ISSN	1932-6203
ISSN (online)	1932-6203
DOI	10.1371/journal.pone.0233806
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Article ; Online: Staying at home: the potential cost savings related to triage advice provided by the New Zealand National Poisons Centre.

Nicholls, Ella / Sullivan, Trudy / Zeng, Jiaxu / Pomerleau, Adam C

Clinical toxicology (Philadelphia, Pa.)

2021 Volume 60, Issue 1, Page(s) 115–121

Abstract: Introduction: Evidence from multiple countries suggests poisons centres create value in several ways including the provision of expert clinical advice, decreased hospital length of stay and triage of exposures enabling safe management without further ... ...

Abstract	Introduction: Evidence from multiple countries suggests poisons centres create value in several ways including the provision of expert clinical advice, decreased hospital length of stay and triage of exposures enabling safe management without further medical utilisation. Data specific to the New Zealand context are lacking. Therefore, this study aimed to estimate one aspect of poison centre value, namely the potential savings to the health system related to triage advice provided by the New Zealand National Poisons Centre (NZNPC). Methods: A prospective survey was conducted over a 2-week period where eligible NZNPC callers - who were advised their exposure did not require further medical assessment - were asked what alternative action they would have taken in the hypothetical absence of the NZNPC. The potential cost savings associated with the alternative actions respondents would have taken were calculated using publicly available information and extrapolated to the population level using annual NZNPC call numbers for 2019. Results: Among 554 eligible callers, 399 were recruited to participate and 396 provided responses. The single most common alternative action was "search the Internet" (54/396, 14%). In-person medical assessment would have been sought by 25% (100/396), and 39% (154/396) would have called an alternative provider within the healthcare system. The estimated cost associated with alternative actions for the study period was NZ$25,637. When extrapolated to the 2019 year, the potential savings from avoided healthcare utilisation was NZ$1,061,551. Conclusion: In 2019, in the absence of NZNPC triage advice, a conservatively estimated NZ$1,061,551 would have been spent on healthcare related to poisoning exposures that were appropriate for management without further medical utilisation. It is important to note that this estimate is only one aspect of the total value created by the NZNPC and is consistent with findings of value from other poisons centres internationally.
MeSH term(s)	Cost Savings ; Humans ; New Zealand/epidemiology ; Poison Control Centers ; Poisons ; Prospective Studies ; Triage
Chemical Substances	Poisons
Language	English
Publishing date	2021-06-17
Publishing country	England
Document type	Journal Article
ZDB-ID	204476-6
ISSN	1556-9519 ; 0009-9309 ; 0731-3810 ; 1556-3650
ISSN (online)	1556-9519
ISSN	0009-9309 ; 0731-3810 ; 1556-3650
DOI	10.1080/15563650.2021.1937641
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Article: A Case of Strychnine Poisoning from a Southeast Asian Herbal Remedy.

Singhapricha, Terry / Pomerleau, Adam C

The Journal of emergency medicine

2017 Volume 52, Issue 4, Page(s) 493–495

Abstract: Background: Strychnine is a highly toxic alkaloid found in both naturally occurring compounds and commercial products. Extracts of fruits from the strychnine plant have been used in Southeast Asia as remedies for various illnesses. We describe ... ...

Abstract	Background: Strychnine is a highly toxic alkaloid found in both naturally occurring compounds and commercial products. Extracts of fruits from the strychnine plant have been used in Southeast Asia as remedies for various illnesses. We describe strychnine poisoning from ingestion of a Southeast Asian herbal supplement quantitatively confirmed by serum and urine analysis. Case report: A 40-year-old Cambodian woman presented to the emergency department with a complaint of jaw pain and spasms. The patient was staying with a relative and drank 2 oz from an unmarked bottle that she thought contained vodka. She then developed trismus and abdominal cramping, after which a family member said the bottle contained a compound called "slang nut." Her vital signs were as follows: heart rate 102 beats/min, blood pressure 142/72 mm Hg, respiratory rate 20 breaths/min, and oxygen level 100%. The physical examination revealed no significant abnormalities. Serum toxicologic screens were negative except for strychnine levels that revealed a serum concentration of 350 ng/mL and a urine concentration >200 ng/mL. The patient was observed for 2.5 h and discharged with no long-term complications. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: Strychnine is a well-known compound that has been used in poisons, rodenticides, and performance enhancing drugs for years. In the Western world, strychnine is a much less common poisoning given that its use has been restricted because of the potential for severe toxicity; however, given its potentially high mortality, it is important to be aware of other sources of exposure, including those from herbal and homeopathic remedies.
Language	English
Publishing date	2017-04
Publishing country	United States
Document type	Journal Article
ZDB-ID	605559-x
ISSN	0736-4679
ISSN	0736-4679
DOI	10.1016/j.jemermed.2016.10.007
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Article ; Online: Stocks of paracetamol products stored in urban New Zealand households

Eeva-Katri Kumpula / Pauline Norris / Adam C Pomerleau

PLoS ONE, Vol 15, Iss 6, p e

A cross-sectional study.

2020 Volume 0233806

Abstract: BACKGROUND:Intentional self-harm is a common cause of hospital presentations in New Zealand and across the world, and self-poisoning is the most common method of self-harm. Paracetamol (acetaminophen) is frequently used in impulsive intentional overdoses, ...

Abstract	BACKGROUND:Intentional self-harm is a common cause of hospital presentations in New Zealand and across the world, and self-poisoning is the most common method of self-harm. Paracetamol (acetaminophen) is frequently used in impulsive intentional overdoses, where ease of access may determine the choice of substance. OBJECTIVE:This cross-sectional study aimed to determine how much paracetamol is present and therefore accessible in urban New Zealand households, and sources from where it has been obtained. This information is not currently available through any other means, but could inform New Zealand drug policy on access to paracetamol. METHODS:Random cluster-sampling of households was performed in major urban areas of two cities in New Zealand, and the paracetamol-containing products, quantities, and sources were recorded. Population estimates of proportions of various types of paracetamol products were calculated. RESULTS:A total of 174 of the 201 study households (86.6%) had at least one paracetamol product. Study households had mostly prescription products (78.2% of total mass), and a median of 24.0 g paracetamol present per household (inter-quartile range 6.0-54.0 g). Prescribed paracetamol was the main source of large stock. Based on the study findings, 53% of New Zealand households had 30 g or more paracetamol present, and 36% had 30 g or more of prescribed paracetamol, specifically. CONCLUSIONS:This study highlights the importance of assessing whether and how much paracetamol is truly needed when prescribing and dispensing it. Convenience of appropriate access to therapeutic paracetamol needs to be balanced with preventing unnecessary accumulation of paracetamol stocks in households and inappropriate access to it. Prescribers and pharmacists need to be aware of the risks of such accumulation and assess the therapeutic needs of their patients. Public initiatives should be rolled out at regular intervals to encourage people to return unused or expired medicines to pharmacies for safe disposal.
Keywords	Medicine ; R ; Science ; Q
Subject code	360
Language	English
Publishing date	2020-01-01T00:00:00Z
Publisher	Public Library of Science (PLoS)
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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Article ; Online: Therapeutic errors captured by the New Zealand National Poisons Centre: a retrospective audit.

Yang, Nicholas Y / Pomerleau, Adam C / Shieffelbien, Lucy M / Kunac, Desirée L / Braund, Rhiannon

Journal of primary health care

2021 Volume 13, Issue 1, Page(s) 63–69

Abstract: INTRODUCTION Medication errors are one important cause of harm to patients. Information about medication errors can be obtained from diverse sources, including databases administered by poisons centres as part of their routine operation. AIM The aim of ... ...

Abstract	INTRODUCTION Medication errors are one important cause of harm to patients. Information about medication errors can be obtained from diverse sources, including databases administered by poisons centres as part of their routine operation. AIM The aim of this study was to describe the data regarding therapeutic errors captured by the New Zealand National Poisons Centre (NZNPC). METHODS A retrospective study of calls made to the NZNPC between 1 September 2016 and 31 August 2018 was conducted, which involved human patients and were classified as 'therapeutic error' in the NZNPC database. Variables extracted and analysed included the demographics of the individual, the substance(s) involved, and site of exposure. RESULTS During the study period, a total of 43,578 calls were received by the NZNPC, including 5708 (13%) that were classified as 'therapeutic error'. Just over half of the exposures occurred in females, 3197 (56%) and 4826 (85%) of the calls involved a single substance. All age groups were affected and 2074 (37%) of the calls were related to children aged <12 years. A residential environment (n=5568, 97%) was the site of exposure for almost all reported therapeutic errors, most commonly in the patient's own home (n=5207, 91%). DISCUSSION This study provides insights into therapeutic error-related calls to the NZNPC. Almost all errors occurred in the residential setting. Over one-third of the calls involved children. Enhanced data capture and classification methods are needed to determine the types of errors and their possible causes to better inform prevention efforts.
MeSH term(s)	Child ; Female ; Humans ; Medication Errors ; New Zealand/epidemiology ; Poison Control Centers ; Poisons ; Retrospective Studies
Chemical Substances	Poisons
Language	English
Publishing date	2021-03-30
Publishing country	Australia
Document type	Journal Article
ZDB-ID	2572943-3
ISSN	1172-6156 ; 1172-6156
ISSN (online)	1172-6156
ISSN	1172-6156
DOI	10.1071/HC20066
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