- Email: [email protected]
Poison Prevention
-
Poison Prevention Its NotJust a One--Week Effort
around the pharmacy, keeping himself amused while his mother waited for the prescription I was preparing. Kids act fast, and before anyone knew it, the boy was standing there with the half-empty bottle in his hand, a sticky red liquid running down his chin and onto his sweater.
An Unforgettable Experience It was just a harmless cough syrup, and the amount he drank was not enough to cause any real problems, but neither the mother nor I will ever forget that experience-it created an awareness of the importance of poison prevention that has stayed with me to this day. Like motherhood and apple pie, poison preven tion is a concept everyone believes in, but it takes a close and personal experience to . bring out the crusader in a person. Pharmacists are no different. For many, poison prevention is a cause celebre, while others look on it as little more than the subject of another national "week" observance. And that's ironic, for it was a Missouri pharmacist, Horner A. George of Cape Girardeau, Missouri, who origina ted the concept of National Poison Prevention Week. His efforts, supported by the profession, led to a joint House and Senate resolution which in 1961 was signed into law by then-President John F. Kennedy. Since then, National Poison Prevention Week has been actively supported by the American Pharmaceutical Association and the profession. More than 8,000 groups now take part in this effort, as well as in year-round prevention programs.
By RONALD' L. WILLIAMS _ _ _ _ _ _ _ _ _ _ _ _ _ _-----t
Once you've looked into the anguished face of a mother whose child has just been poisoned, you never forget it. Pharmacists don't usually corne into direct contact with poisoning-
Ronald L. Williams is executive secretary of the APhA Academy of Pharmacy Practice.
American Pharmacy Vol.NS19, No.2, Feb.1979/77
l
more often the tragedy is manifested in a frantic, sometimes hysterical, telephone call. We've all had them, and it's a sobering experience. When it happens in the pharmacy, it brings the impact a lot closer to home. Looking back, it wasn't really that serious. But at the time it wasboth to me and to the mother. Her three-year-old son was wandering
Need Still Exists Is there still a need for poison prevention programs? The statistics say there is. In 1976, the most recent year for which statistics are available, the National Clearinghouse for Poison Control Centers processed 147,277 case reports of ingestions. As expected, the largest number-89,755-involved children under five years of age. What is surprising to many, however, is the category most frequently involved
21 1
o
in the ingestions: house plants, representing approximately 10 percent of all reported ingestions by children in this age group. Completing the top five categories were soaps, detergents and cleaners, vitamins and minerals, aspirin (once the runaway leader), and antihistamines. There is little doubt that childresistant packaging has played a significant role in knocking aspirin down to the number four spot. Ingestions of aspirin-the first drug for which safety packaging was required under the Poison Prevention Packaging Act of 1970-has declined 48 percent since 1972, and
22
preliminary tabulations indicate that figure will top 60 percent when the latest statistics are released. The success with aspirin has been so dramatic that the Consumer Product Safety Commission has recently proposed that child-resistant packaging requirements be established for products containing acetaminophen, another substance shown to be a poisoning problem in children under five years of age. As effective as safety packaging has been in reducing childhood poisonings, no one claims that such packaging in itself is sufficient to eliminate accidental poisonings in children. Most authorities agree
that an educational effort must be coupled with safer packaging to make real progress in combating childhood poisonings . Children must be taught at an early age to recognize the dangers of hazardous substances.
New Symbolism Changes in the symbolism used to warn against poisonous substances have helped. Experience showed that the traditional warning sign for hazardous substances-the skull and crossbones-had lost its effectiveness as a warning to children and others. In fact, in many cases the symbol had exactly the opposite
American Pharmacy Vol.NS19, No.2, Feb.1979/78
effect. Many children looked at the skull and cr ossbones as a symbol of pirates and were attracted rather than warned off by it. Several symbols have since been proposed to serve as warnings to both children and adults. One of the earliest was the striking serpent, first used by the Michigan Pharmacists Association in 1964. The snake was also adopted as a symbol for poisons by the Brokaw Poison Center in Normal, Illinois. The Brokaw serpent, which is the center of a comprehensive poison prevention pr ogram, has the name "Siop." Children are taught to say "No Siop" (poison spelled backward) when they see the symbol, and they are also t aught never to touch "Siop." Mr. Yuk, a symbol developed by the Childr en's Hospital of Pittsburgh, and Officer Ugg, the creation of the Rocky Mountain Poison Center in Denver, are two other attempts at designing symbols that have a meaning to both children and adults. Alth ough symbols and childresistant packaging are helpful in combat ing accidental poisoning, they can go only so far toward substantially reducing or eliminating accidental poisoning. Parents must be reminded constantly that they must play an active role in prevent-
Ameri can Pharmacy VoI.NS19 , No.2 , Feb.1979/79
o
ing a poisoning tragedy in their homes, .and they must be prepared to cope with a poisoning emergency if it occurs .
Syrup of Ipecac You now have in your pharmacy a powerful weapon against poisoning deaths, if you can just get it into the hands of parents with young children. That weapon is syrup of ipecac. This safe and effective emetic is not a new weapon, but only recently has it finally become recognized as one of the most effective poison preventatives around. The American Pharmaceutical Association has had official policy advocating the use of the preparation for well over a decade, but it is only within the past year or so that governmental agencies such as the Consumer Product Safety Commission and the Food and Drug Administration have actively promoted syrup of ipecac as a poisoning antidote. Except in the case of ingestion of corrosive substances such as drain or oven cleaners, emesis is the best measure to prevent the absorption of toxic substances, and syrup of ipecac does the job. For children over the age of one year, a tablespoonful of the preparation, together with at least a cup of water, will usually induce vomiting, although the dose can be repeated
after about 20 minutes if vomiting has not occurred. Drugs are not the only offenders in accidental poisonings, of course . As we already noted, house plants now head the list, and a host of other hazardous substances lurking around the average home are often implicated when a poisoning occurs. Of the top 10 culprits, four besides plants-perfumes, insecticides, disinfectants, and deodorizers-are in nondrug categories. As a result, poison-proofing the home has often been the theme of poison prevention campaigns. Parents need to be made aware that the family medicine chest is not the only place deserving attentionkitchens, garages, and other storage areas are just as important and are more likely to be neglected. Even though a great deal of progress has been made in reducing the number of accidental poisonings, we still have a long way to go. National Poison Prevention Week is a valuable aid in emphasizing the problem, but poison prevention activities must go on 365 days a year.
Commitment What can you do? Many things . There is no planned prevention program that will fit your individual situation exactly, but there are examples of poison prevention activi-
23
~~~~~~~~~~~~~~~~~~~ having an impact on the number of 1 pharmacist in the country had been ties from which to choose (see box). Poison prevention doesn't have to be a major project that demands a great deal of your time. However, it is an activity that requires your commitment and persistence. We don't have to do a lot to make a big impact on the problem. If every
successful in preventing just one poison ingestion in 1976, the more than 147,000 cases reported that year would have been reduced by at least two thirds-and that's quite a reduction. If you are really serious about
accidental poison ingestions among the patients you serve, it can't be a one-week effort. It's a job to keep working at every week of the year. 0
WhatYouGmDo The following suggestions may provide you with some guidelines to follow in planning your own poison prevention program. • Distribute educational materials. There is a wealth of materials available from a variety of sources. For a comprehensive list of materials, write: National Planning Council for National Poison Prevention Week, P.O. Box 1543, Washington, DC 20013. • Make emergency phone numbers available. For your own use and that of your patients, the telephone number of your nearest poison control center should be available. A directory of centers can be obtained from the National Clearinghouse for Poison Control Centers, 5401 Westbard Avenue, Bethesda, MD 20016 . Some pharmacists have had this number, along with that of hospital emergency rooms in their area, printed on gummed stickers that can be applied to the inside of a medicine chest or near th~ telephone. • Sponsor advertisements. If you have a regular advertising campaign for your pharmacy, occasionally make poison prevention the subject. At special times, like National Poison Prevention Week, several pharmacies in your area might pool resources to run a larger joint ad. • Collect outdated prescription medications. Many pharmacists have had great success in offering a "bounty" for old prescription bottles that accumulate in many medicine chests. The payment usually takes the form of a credit which may be applied to the patient's next prescription purchase.
24
• Run a poster contest. Sponsor a poison prevention poster contest, either as a program for your patients' families or in conjunction with local schools, complete with prizes and an exhibit of the winning entries in your pharmacy. • Hit the speakers' circuit. Take the message of poison prevention on the road by talking before community and school groups. • Promote syrup of ipecac. Display it prominently in the pharmacy. Some pharmacies have distributed free bottles of the emetic during National Poison Prevention Week. • Encourage media attention. Talk to e~itors of local newspapers and radio and television station managers about using National Poison Prevention Week promotional materials and giving attention to poison prevention all year long. • Get auxiliaries involved. In most cases, that won't be necessary, for pharmacy auxiliaries have been long-time supporters of poison prevention activities. The APhA Auxiliary, for example, for many years has urged its members to work with school children and has developed the puppet show, "Remember Little Jill," as an aid. • Promote proper use of safety caps. Child-resistant packaging has become so commonplace that you may forget the problems patients had with them when they were first introduced. Don't assume there are no problems just because you may hear fewer complaints. It's still important that patients are instructed about the proper use of safety caps and that patients unable to cope
with them are made aware of their right to request conventional packaging. • Don't forget students. If you have a pharmacy student working in your pharmacy or if you are located near a school of pharmacy, don't underestimate the amount of help that students can give you. Poison prevention has been a major activity of the Student American Pharmaceu- I tical Association for years, and many chapters have developed extremely effective programs. • Team up with other health professionals. Poison prevention is an activity ripe for interprofessional cooperation, and many other health professionals-especially pedia tricians-will welcome your help in developing cooperative programs . • Zero in on baby-sitters. Parents are not the only persons who should be aware of poisoning hazards. Teenage baby sitters also should be thoroughly familiar with preven tative measures and should know what to do if one of their charges is involved in an accidental ingestion. • Use window displays. If your pharmacy has a display window, remember that it can be used to promote things other than productspoison prevention is a good example. • Train your personnel. The people who work in your pharmacy often have more contact with people than you do, and that opportunity can be put to good use if you explain to them the importance of poison prevention and what parents should be told.
American Pharmacy VoI.NS19, No.2, Feb.1979/80 ------0lIl
Poison Prevention Its NotJust a One--Week Effort
around the pharmacy, keeping himself amused while his mother waited for the prescription I was preparing. Kids act fast, and before anyone knew it, the boy was standing there with the half-empty bottle in his hand, a sticky red liquid running down his chin and onto his sweater.
An Unforgettable Experience It was just a harmless cough syrup, and the amount he drank was not enough to cause any real problems, but neither the mother nor I will ever forget that experience-it created an awareness of the importance of poison prevention that has stayed with me to this day. Like motherhood and apple pie, poison preven tion is a concept everyone believes in, but it takes a close and personal experience to . bring out the crusader in a person. Pharmacists are no different. For many, poison prevention is a cause celebre, while others look on it as little more than the subject of another national "week" observance. And that's ironic, for it was a Missouri pharmacist, Horner A. George of Cape Girardeau, Missouri, who origina ted the concept of National Poison Prevention Week. His efforts, supported by the profession, led to a joint House and Senate resolution which in 1961 was signed into law by then-President John F. Kennedy. Since then, National Poison Prevention Week has been actively supported by the American Pharmaceutical Association and the profession. More than 8,000 groups now take part in this effort, as well as in year-round prevention programs.
By RONALD' L. WILLIAMS _ _ _ _ _ _ _ _ _ _ _ _ _ _-----t
Once you've looked into the anguished face of a mother whose child has just been poisoned, you never forget it. Pharmacists don't usually corne into direct contact with poisoning-
Ronald L. Williams is executive secretary of the APhA Academy of Pharmacy Practice.
American Pharmacy Vol.NS19, No.2, Feb.1979/77
l
more often the tragedy is manifested in a frantic, sometimes hysterical, telephone call. We've all had them, and it's a sobering experience. When it happens in the pharmacy, it brings the impact a lot closer to home. Looking back, it wasn't really that serious. But at the time it wasboth to me and to the mother. Her three-year-old son was wandering
Need Still Exists Is there still a need for poison prevention programs? The statistics say there is. In 1976, the most recent year for which statistics are available, the National Clearinghouse for Poison Control Centers processed 147,277 case reports of ingestions. As expected, the largest number-89,755-involved children under five years of age. What is surprising to many, however, is the category most frequently involved
21 1
o
in the ingestions: house plants, representing approximately 10 percent of all reported ingestions by children in this age group. Completing the top five categories were soaps, detergents and cleaners, vitamins and minerals, aspirin (once the runaway leader), and antihistamines. There is little doubt that childresistant packaging has played a significant role in knocking aspirin down to the number four spot. Ingestions of aspirin-the first drug for which safety packaging was required under the Poison Prevention Packaging Act of 1970-has declined 48 percent since 1972, and
22
preliminary tabulations indicate that figure will top 60 percent when the latest statistics are released. The success with aspirin has been so dramatic that the Consumer Product Safety Commission has recently proposed that child-resistant packaging requirements be established for products containing acetaminophen, another substance shown to be a poisoning problem in children under five years of age. As effective as safety packaging has been in reducing childhood poisonings, no one claims that such packaging in itself is sufficient to eliminate accidental poisonings in children. Most authorities agree
that an educational effort must be coupled with safer packaging to make real progress in combating childhood poisonings . Children must be taught at an early age to recognize the dangers of hazardous substances.
New Symbolism Changes in the symbolism used to warn against poisonous substances have helped. Experience showed that the traditional warning sign for hazardous substances-the skull and crossbones-had lost its effectiveness as a warning to children and others. In fact, in many cases the symbol had exactly the opposite
American Pharmacy Vol.NS19, No.2, Feb.1979/78
effect. Many children looked at the skull and cr ossbones as a symbol of pirates and were attracted rather than warned off by it. Several symbols have since been proposed to serve as warnings to both children and adults. One of the earliest was the striking serpent, first used by the Michigan Pharmacists Association in 1964. The snake was also adopted as a symbol for poisons by the Brokaw Poison Center in Normal, Illinois. The Brokaw serpent, which is the center of a comprehensive poison prevention pr ogram, has the name "Siop." Children are taught to say "No Siop" (poison spelled backward) when they see the symbol, and they are also t aught never to touch "Siop." Mr. Yuk, a symbol developed by the Childr en's Hospital of Pittsburgh, and Officer Ugg, the creation of the Rocky Mountain Poison Center in Denver, are two other attempts at designing symbols that have a meaning to both children and adults. Alth ough symbols and childresistant packaging are helpful in combat ing accidental poisoning, they can go only so far toward substantially reducing or eliminating accidental poisoning. Parents must be reminded constantly that they must play an active role in prevent-
Ameri can Pharmacy VoI.NS19 , No.2 , Feb.1979/79
o
ing a poisoning tragedy in their homes, .and they must be prepared to cope with a poisoning emergency if it occurs .
Syrup of Ipecac You now have in your pharmacy a powerful weapon against poisoning deaths, if you can just get it into the hands of parents with young children. That weapon is syrup of ipecac. This safe and effective emetic is not a new weapon, but only recently has it finally become recognized as one of the most effective poison preventatives around. The American Pharmaceutical Association has had official policy advocating the use of the preparation for well over a decade, but it is only within the past year or so that governmental agencies such as the Consumer Product Safety Commission and the Food and Drug Administration have actively promoted syrup of ipecac as a poisoning antidote. Except in the case of ingestion of corrosive substances such as drain or oven cleaners, emesis is the best measure to prevent the absorption of toxic substances, and syrup of ipecac does the job. For children over the age of one year, a tablespoonful of the preparation, together with at least a cup of water, will usually induce vomiting, although the dose can be repeated
after about 20 minutes if vomiting has not occurred. Drugs are not the only offenders in accidental poisonings, of course . As we already noted, house plants now head the list, and a host of other hazardous substances lurking around the average home are often implicated when a poisoning occurs. Of the top 10 culprits, four besides plants-perfumes, insecticides, disinfectants, and deodorizers-are in nondrug categories. As a result, poison-proofing the home has often been the theme of poison prevention campaigns. Parents need to be made aware that the family medicine chest is not the only place deserving attentionkitchens, garages, and other storage areas are just as important and are more likely to be neglected. Even though a great deal of progress has been made in reducing the number of accidental poisonings, we still have a long way to go. National Poison Prevention Week is a valuable aid in emphasizing the problem, but poison prevention activities must go on 365 days a year.
Commitment What can you do? Many things . There is no planned prevention program that will fit your individual situation exactly, but there are examples of poison prevention activi-
23
~~~~~~~~~~~~~~~~~~~ having an impact on the number of 1 pharmacist in the country had been ties from which to choose (see box). Poison prevention doesn't have to be a major project that demands a great deal of your time. However, it is an activity that requires your commitment and persistence. We don't have to do a lot to make a big impact on the problem. If every
successful in preventing just one poison ingestion in 1976, the more than 147,000 cases reported that year would have been reduced by at least two thirds-and that's quite a reduction. If you are really serious about
accidental poison ingestions among the patients you serve, it can't be a one-week effort. It's a job to keep working at every week of the year. 0
WhatYouGmDo The following suggestions may provide you with some guidelines to follow in planning your own poison prevention program. • Distribute educational materials. There is a wealth of materials available from a variety of sources. For a comprehensive list of materials, write: National Planning Council for National Poison Prevention Week, P.O. Box 1543, Washington, DC 20013. • Make emergency phone numbers available. For your own use and that of your patients, the telephone number of your nearest poison control center should be available. A directory of centers can be obtained from the National Clearinghouse for Poison Control Centers, 5401 Westbard Avenue, Bethesda, MD 20016 . Some pharmacists have had this number, along with that of hospital emergency rooms in their area, printed on gummed stickers that can be applied to the inside of a medicine chest or near th~ telephone. • Sponsor advertisements. If you have a regular advertising campaign for your pharmacy, occasionally make poison prevention the subject. At special times, like National Poison Prevention Week, several pharmacies in your area might pool resources to run a larger joint ad. • Collect outdated prescription medications. Many pharmacists have had great success in offering a "bounty" for old prescription bottles that accumulate in many medicine chests. The payment usually takes the form of a credit which may be applied to the patient's next prescription purchase.
24
• Run a poster contest. Sponsor a poison prevention poster contest, either as a program for your patients' families or in conjunction with local schools, complete with prizes and an exhibit of the winning entries in your pharmacy. • Hit the speakers' circuit. Take the message of poison prevention on the road by talking before community and school groups. • Promote syrup of ipecac. Display it prominently in the pharmacy. Some pharmacies have distributed free bottles of the emetic during National Poison Prevention Week. • Encourage media attention. Talk to e~itors of local newspapers and radio and television station managers about using National Poison Prevention Week promotional materials and giving attention to poison prevention all year long. • Get auxiliaries involved. In most cases, that won't be necessary, for pharmacy auxiliaries have been long-time supporters of poison prevention activities. The APhA Auxiliary, for example, for many years has urged its members to work with school children and has developed the puppet show, "Remember Little Jill," as an aid. • Promote proper use of safety caps. Child-resistant packaging has become so commonplace that you may forget the problems patients had with them when they were first introduced. Don't assume there are no problems just because you may hear fewer complaints. It's still important that patients are instructed about the proper use of safety caps and that patients unable to cope
with them are made aware of their right to request conventional packaging. • Don't forget students. If you have a pharmacy student working in your pharmacy or if you are located near a school of pharmacy, don't underestimate the amount of help that students can give you. Poison prevention has been a major activity of the Student American Pharmaceu- I tical Association for years, and many chapters have developed extremely effective programs. • Team up with other health professionals. Poison prevention is an activity ripe for interprofessional cooperation, and many other health professionals-especially pedia tricians-will welcome your help in developing cooperative programs . • Zero in on baby-sitters. Parents are not the only persons who should be aware of poisoning hazards. Teenage baby sitters also should be thoroughly familiar with preven tative measures and should know what to do if one of their charges is involved in an accidental ingestion. • Use window displays. If your pharmacy has a display window, remember that it can be used to promote things other than productspoison prevention is a good example. • Train your personnel. The people who work in your pharmacy often have more contact with people than you do, and that opportunity can be put to good use if you explain to them the importance of poison prevention and what parents should be told.
American Pharmacy VoI.NS19, No.2, Feb.1979/80 ------0lIl