Clinical Toxicology

ISSN: 0009-9309 (Print) (Online) Journal homepage: http://www.tandfonline.com/loi/ictx18

The Role of the Pharmacist in the Control of Acute

Poisoning

William J. Kinnard

To cite this article: William J. Kinnard (1971) The Role of the Pharmacist in the Control of Acute
Poisoning, Clinical Toxicology, 4:4, 659-663, DOI: 10.3109/15563657108990991

To link to this article: https://doi.org/10.3109/15563657108990991

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CLINlCAL TOXICOLOGY, 4(4), pp. 659-663, December, 1971

Editorial

The Role of the Pharmacist in the

Control of Acute Poisoning

William J . Kinnard, Jr., Ph.D.

Dean and Professor of Pharmacology and Toxicology
University of Maryland, School of Pharmacy

The toxicological problems caused by acute ingestion of drugs are becom-

ing more numerous in this present era of a drug-oriented society. The
classical ingestions of an accidental nature in small children or the intentional
overdosage of drugs is being suppleinented by the wide misuse or abuse of
drugs. In addition, multiple drug therapy is increasing with its concomitant
drug interaction problem. The prevention and treatment of these various
toxicological problems require a better coordination of our health manpower
resources. The pharmacist, as a drug specialist, often overlooked in the past,
can play an important role in the development of a specialized health care
team.
It has been pointed out in recent years that toxicology should become a
major discipline within schools of pharmacy because of the many strengths in-
herent in the curricula of the school [ 1,2] . As far back as 1922, pharmacy
schools required 26 hours of toxicology as part of the requirements for the
Ph. G. degree [2]. Over the years the requirement was eliminated and interest
in toxicology as a discipline decreased; however, in recent years this trend has
been reversed. Several schools are restructuring their pharmacology depart-
ments into departments of pharmacology and toxicology. One school, St.
John’s University, has instituted a four-year program in toxicology leading t o
a B. S. degree. Students obtaining the degree after taking courses within that

659
Copyright 0 1971 by Marcel Dekker, Inc. NO PART of this work may be reproduced
or utilized in any form or by any means, electronic or mechanical, including xerography,
photocopying, microfilm, and recording, or by any information storage and retrieval
system, without the written permission of the publisher.
660 EDITORIAL

school can follow careers as toxicology technicians or move into graduate

programs leading to the Ph. D. degree.
This interest in toxicology is developing at the same time that a major
thrust in curriculum revision is occurring in pharmacy schools. Almost all
schools are attempting t o reorient the pharmacy curriculum toward a
patient care orientation rather than the older concept which was basically
aimed at the drug product. Pharmacy students are now working in clinical
situations in institutional and community settings, performing many patient
care services hitherto not part of their academic program. Many hospitals
are developing clinical pharmacy services which are designed to improve
patient care and provide for a more effective and economical delivery of
drugs.
How can the pharmacist participate in a typical poisoning case? The
initial patient contact with the treatment system is a triage point, often the
poison control center, where information is sought as to whether or not the
material ingested is poisonous, and whether treatment should be undertaken.
A second point of contact is arrival of the patient at the primary treatment
center, and the subsequent therapy that ensues. Following treatment, the
evaluation of that treatment and of the patient’s home environment is also
another point of consideration. The pharmacist’s roles in this scheme are
numerous. First of all, the triage officer can very well be a pharmacist.
This individual would be staffing a poison information center for a large city
or state operation, or in particular hospital. A detailed knowledge of over-
the-counter and prescription drugs, and other potentially dangerous material,
such as plants, is included in the training of the modem pharmacist. This
one individual, then, can serve to make judgment as to types of material
ingested and the toxic liability of that material, something that cannot be
achieved through the use of a secretary or clerk, or in some cases by a
medical resident who is on call. The pharmacist not only can readily
identify the various materials, but more often is more familiar with the pos-
sibility that the person who has ingested some material may also be taking
some medication for some other reason. This concurrent ingestion of non-
prescription drugs can be identified by the triage officer through a patient
drug history. Dr. Edmund Pellegrino, Vice President for Health Sciences at
S U N Y Stonybrook, in a recent talk before a conference at the University
of California, pointed out that the pharmacist is the logical person to serve
as the poison control officer and in addition, has many roles in the primary
treatment centers that could be set up throughout the inner city. In the
development of the triage concept, some thought should be given to the
community pharmacists who are serving throughout a particular area. A
special continuing education program should be provided to them so that
EDITORIAL 66 I

they could receive updated poison control and drug information, and,
while receiving this educational input, could serve in initial triage efforts,
with the central information service office acting as a resource for the
pharmacist.
Upon the arrival of the patient at the treatment center there are a number
of steps that could involve the pharmacist. As was pointed out, the modern
pharmacist is being trained in clinical pharmacy, which implies direct patient
care. A number of hospitals are developing satellite pharmacies in emergency
rooms to provide both specific clinical and traditional dispensing pharmacy
services for that area. This would become more important as emergency
room services in hospitals begin to move more in the direction of true emer-
gency services, splitting away the ambulatory care that is needed in evening
hours for the typical clinic patient. One of the first functions of the pharma-
cist would be the identification of the particular ingested material, not only
through the gross examination of the product, but the specific analysis of the
ingested material. This ability has been acquired by the pharmacist through
his training in analytical and medicinal chemistry. Following identification
of the expected poison, the therapy again can have an input from the
pharmacist. Through the control of drugs in the emergency room, especially
if a unit dose system is in operation, he can help provide accurate drug
therapy for the patient. Many hospitals are now placing the responsibility
for the preparation and administration of all intravenous medication under
the pharmacy; also pharmacists are members of the cardiac arrest team. In
an increasing number of hospitals, the pharmacist is in charge of drug ad-
ministration (and in some cases blood and blood products) directly to the
patient. This could extend into the emergency room. It should be pointed
out that the development of a specific emergency room formulary and the
selection of therapeutically effective drug dosage forms should have a high
priority in any modern treatment center.
If the ingested material is not a common item involvement, treatment
information must be sought. The drug information unit of any large medical
center can serve as a resource for this information. Hospital pharmacies do
have limited information sources, but a number of major health centers,
especially those connected with universities, are developing health information
services that have great depth. These can be used to bring out the exact de-
tails of treatment and provide a better idea of the prognosis of the patient
following that treatment. Several universities in the United States have
graduate programs in drug information. This is a new field and the graduates
of these areas are rather limited in number. However, there is a major ex-
pansion of this area in many schools of pharmacy in the United States, and
in the near future we should have adequate numbers of highly trained drug
662 EDITORIAL

information specialists who can serve as resource officers, with one of their
roles being the documentation of treatment techniques for use in acute
intoxication.
Another aspect of patient care is the follow-up protocol that should be
used on the return of the patient to his home or to the environment in
which the poisoning occurred. The information sought by the poison con-
trol officer would identify: if the patient heeded all of the instructions at
the poison control center, if treatment did occur, and what type was used.
But more importantly is the preventive aspect of a follow-up investigation;
that is, will the patient be again involved in an acute ingestion. Is the en-
vironment safe? Is the knowledge of the patient sufficient that they un-
derstand what has occurred and that every effort is made to prevent this
ingestion from occurring again? In many of the situations, the homes that
involve ingestions are visited by nurses or social workers from the health
department. These individuals are not trained in the aspects of toxicology
so that they can function adequately in this situation. Thus, many areas,
short training programs should be developed through schools of pharmacy
to ensure that these workers can recognize the presence of dangerous drugs
or potential poisons, to recommend their removal or change in storage area,
and to recognize the potential abuse drugs coming from the street such as
marijuana, LSD, etc.
The last item to be mentioned, and perhaps the most important, is the
preventive aspect of accidental ingestion. Once a year Poison Prevention
Week is announced, banners are strung, and Presidential proclamations are
made. Concern generally peaks during that time, and then trails off to be
revived again upon administrative lashings from those showing an interest
in the topic. It would appear that a long term information program must
be developed. Once primary area of patient contact with the health care
team is the community pharmacy. More people approach the pharmacist
for information on health care than any other type of practitioner. He
is the so-called first line of patient contact. The American Pharmaceutical
Association for a number of years has provided materials in drug informa-
tion kits that can be distributed to community pharmacies. These materials
involve many aspects of health care ranging from vaccination campaigns to
drug toxicity problems. It would appear that concerted efforts throughout
the year should be made to use the community pharmacist as a distributor
of poison preventive publications that would provide information on:
emergency treatment of poisonings, the recognition of poisonous materials,
how the homemake can poison-proof their home, etc. In this regard, then
the community pharmacist can serve as an excellent vehicle for the dis-
tribution of this material.
EDITORIAL 663

In summary, the outstanding problems involving acute drug toxicology re-

quire that all members of the health team cooperate in the prevention &nd
the treatment of poisonings. The pharmacist through his training is virtually
an untapped reservoir of information and abilities that can be used effectively
in an acute intoxication center. It is suggested that those directing or work-
ing in active centers speak with the directors of the pharmacy services within
a particular hospital, and contact the pharmacy schools that are close to you
to see what resources are available. These discussions will reveal a wealth o f
untapped talent that is readily accessible.

REFERENCES

111 J. Autian, Am. J. Phur. Educ., 32, 557 (1968).

121 W. L. Guess, Am. J. Phur. Educ., 31, 447 (1967).