Pharmacist-Managed Toxicology Consult Service at the Ottawa Hospital: EVALUATION OF THE SERVICE
The TCS was evaluated with the following objectives: first, to describe the epidemiology of patients referred to the service over a 1-year period; second, to evaluate written consultation notes for the same 1-year period to determine the presence of components perceived as essential by referring physicians; and third, to survey former pharmacy residents to determine their perceptions of values and skills gained from participating in the program.
This evaluation was approved by the Research and Ethics Board of the Ottawa Hospital. viagra jelly
Epidemiology of Referred Patients
Consecutive patients for whom toxicology consults were sought during the 1-year period from June 2005 to May 2006 were identified prospectively by the residents on call. Data related to demographic characteristics, severity of illness, source of exposure, resource utilization, clinical outcomes, and recommendations made by the on-call resident were extracted from the written consults, medical records, and laboratory databases. The type of exposure was categorized by drug class. For the same study period, records from the emergency department were screened to determine the proportion of all patients with overdose who presented to the emergency department for whom toxicology consults were requested. The data collected from screening logs consisted of sex, date of presentation, type of overdose, and disposition of the patient.
Table 1. Demographic Characteristics of Patients with Overdoses and Toxic Exposures
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Toxicology consults were sought for 58 (17%) of the 346 cases of overdose seen in the emergency department during the 1-year period. Forty-three (74%) of the referred cases involved intentional overdose, and 42 (72%) involved prescription medications (Table 1). Hospital admission was required for 53 (91%) of the referred patients but only 86 (30%) of the 288 patients who were not referred. More than half of the referrals originated in the ICU (35 [60%]), and the in-hospital mortality rate for all referred cases was 5% (3/58). Twenty-eight (48%) of the cases referred to the TCS involved multiple agents, and the most commonly ingested drugs (> 20% of cases) were antipsychotics, antidepressants, benzodiazepines, and opioids.
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