Pharmacist-Managed Toxicology Consult Service at the Ottawa Hospital: DISCUSSION
Pharmacy-managed toxicology consult services are uncommon in North America. In this report, we have described a program that provides a unique service within our hospital and a valuable learning experience for pharmacy residents. This study sets a benchmark for our own quality assurance and educational initiatives and also offers a model for other residency programs. In an effort to improve the TCS at the Ottawa Hospital, we identified deficiencies in our written consultation notes on the basis of components perceived as essential by the physicians who responded to our questionnaire. Although pharmacy residents reported that participation in the program had been a source of stress during their residency, most agreed that the TCS had been an important part of the overall residency program and that their participation had allowed them to cultivate a variety of skills and values that were useful in their subsequent careers.
This study did not include an evaluation of the clinical impact of the TCS. We suspected that consults would be sought preferentially for more complex cases and more severely ill patients. A control group, consisting of patients with overdose for whom consults had not been requested, would have provided data for a comparison of outcomes, but differences between the groups in terms of causes of overdose and illness severity were likely and would have created selection bias. It was subsequently decided that an evaluation of consult content according to user-defined expectations could be used to indirectly determine the utility of the service. The response rate for the physician questionnaire was relatively low (42%), but the number of respondents (28) exceeded our minimum goal of 20; therefore, no further steps were taken to increase the response rate. The physicians’ perceptions of essential content for the consultation note allowed us to evaluate the written consultation notes for completeness. levitra tablets
The 1-year observational cohort revealed a wide variety of toxic exposures for cases referred to the TCS. It appears that consults were sought for the more complex or severe cases, such as ingestion of multiple agents, exposure to chemicals, and ingestion of newer medications (e.g., atypical antipsychotics) for which appropriate management is not well known. The study also provided a useful resource for tailoring future training sessions for residents and back-up senior pharmacists as the epidemiology of overdoses evolves over time. Anecdotal evidence indicates that acetaminophen and salicylates were traditionally the most common overdose agents seen by the TCS, but they now represent less than 20% and less than 10% of referred cases, respectively.
