Life Line — Nurses Keep Vigil in the Texas Poison Center Network
Tuesday October 1, 2002
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After struggling to understand the directions on the "poisoning kit" she bought six months ago, mom goes to the telephone, spots the Poison Help sticker, and dials (800) 222-1222. She gets a calm professional who answers, "Poison control center, how may I help you?" In Texas, the person on the other end is a highly trained and experienced RN who is a certified poison information specialist.
Nursing Experience Is Vital
Every day the staff in the Texas Poison Control Center network, who have access to listings of thousands of substances in the poison information database, handles these types of calls. Nurses are an integral part of the system and play a big role in this sophisticated, high-tech environment.
"Nurses bring their strong clinical and caring skills to poison center evaluations and interventions," says Mary Lou Nester, RN, CSPI, clinical manager at the Texas Panhandle Poison Center in Amarillo. "Because nurses, particularly critical care nurses, assess many patients, they have an edge working in the poison center. They are able to visualize what the caller is saying and can walk someone through a procedure."
Luis Satelo, RN, BSN, CCRN, CSPI, at the West Texas Poison Center in El Paso, has 10 years of critical care experience. "I started working at the poison center in 1997 and was the first registered nurse hired for this center," Satelo says. "The role is very unique, as we try to manage the cases over the telephone." Satelo says nurses must assess the problem and then decide which interventions are needed, based on protocols developed in collaboration with the medical director. "We try to reduce the number of unnecessary visits and calls to already overloaded emergency departments and emergency medical services."
So what would the nurse poison specialist do to help our mom and her 4-year-old? Satelo says a history is taken first, determining what substance was taken and how long ago. Next, the nurse would assess whether the patient is having symptoms and whether anything has already been done. Then he or she would determine if the exposure is toxic or nontoxic. "This is where an experienced nurse's strong clinical skills come in."
After deciding to manage a patient at home, the nurse instructs the caller about the appropriate interventions and then validates the caller's understanding of those instructions. "The callers are often moms or grandparents who are very anxious and guilty about what has happened," Nester says. "Anyone who is a parent or caregiver has been there. We try to reduce the anxiety of the caller and to help them cope with the guilt they are feeling, refocusing their attention on helping the child."
Multifunctional and Multitalented
Whether the patient is managed from home or directed to the ED, the poison center follows up on the case. If the patient is managed from home, the poison center nurse calls back within one hour. Depending on the type of ingestion, the nurse may call again in four to six hours and then again at 23 hours, reassessing the patient at each interval and the effectiveness of any interventions.
If patients are sent to the ED, the poison center calls to see if they arrived. The nurse is also available to assist the ED staff with treatment information. "Once we have decided on an intervention, we may have to walk a nurse or physician through a procedure, particularly one they may not do frequently, such as an Ewald tube insertion," Nester says. "This is where the critical care nurse shines."
Many calls deal with ingestion of over-the-counter and prescription medications. "Our center handles calls regarding ingestion of medications of any type," Satelo says. "As soon as a new drug is approved, we begin to get calls about it, including requests to look it up for pharmacists or physicians practicing in rural areas." Callers also request assistance with or information about ingestions and exposures involving corrosives, natural toxins, insects, environmental poisons, carbon monoxide, cyanide, hydrogen sulfide, chlorines, insecticides, rodentcides, and plants.
Cultural differences are also a challenge. "El Paso is a border city of about 700,000," Satelo says. "All of the staff in our poison center are bilingual, and we get calls from Spanish-speaking residents from both Texas and Mexico. Medication labeling is very different in Mexico, and we receive calls from physicians there seeking substance and treatment information."
So what about our mom and her 4-year-old? Her decision to call the Texas Poison Center Network was a smart move. "If we can start interventions early, we have a better chance to make a difference," says Betty Lieber, RN, BSN, CSPI, who works at the Southeast Texas Poison Center in Galveston. "Some cases can progress very rapidly, so we like to get the treatments started, even if we decide to send the patient to an emergency department for care."
Mom received immediate care for her child from a trained professional nurse who has toxic substance and treatment information available at the click of a mouse. The Texas Poison Center Network is staffed 24/7, and if one center is busy, the calls roll over to another center. Given that the recovery rate of toxins with ipecac syrup decreases to 30% one hour after substance ingestion, with many patients arriving in the ED well over one hour after the ingestion, it looks like she made the right call.
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