National Poisons Information Service

A service commissioned by Public Health England

 

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Members of the public

seeking specific

information on poisons

should contact:

 

In England and Wales:

NHS 111 - dial 111

 

In Scotland:

NHS 24 - dial 111

 

In N Ireland:

Contact your local GP or

pharmacist during

normal hours; click here

(www.gpoutofhours

.hscni.net/) for GP

services Out-of-Hours.

 

In Republic of Ireland:

01 809 2166

 

Healthcare

professionals seeking

poisons information

should consult:

www.toxbase.org

Clinical Governance

The NPIS places the strongest emphasis on the quality of the clinical services it provides and has established rigorous clinical governance mechanisms to ensure that these are maintained. All NPIS Units contribute to a National clinical governance system.

 

To ensure a consistent approach to enquiries and the management of cases, NPIS clinical and information staff are kept informed of relevant issues via a programme of continuing professional development. NPIS procedures are regularly discussed, reviewed and shared (see Box 1). In these ways, NPIS ensures users receive the same high levels of prompt, authoritative and accurate service, wherever and whenever they access it.

 

Box 1. Key features of NPIS clinical governance

 

  • Appropriate induction, training and appraisal of all staff
  • Nationally organised continuous professional development with discussion of contentious issues, ensuring consistency of approach
  • Access to high quality information sources
  • Early peer review of enquiry answers and a programme of enquiry audit
  • Continuous support from senior staff including 24-hour availability of a consultant clinical toxicologist
  • Detailed and regularly updated national operational policies
  • Reporting and review of critical incidents, complaints and near misses so that lessons can be learned and shared throughout the service
  • Regular quality assurance exercises encompassing all aspects of NPIS work

 

In spite of these precautions, things can go wrong, especially for a service that handles so many clinical enquiries. Therefore the NPIS encourages the reporting of critical events, complaints, adverse comments or near misses by all staff members. These can then be investigated and lessons learned across the whole service; when necessary, changes to policies, procedures and clinical advice can be made. Reported incidents are reviewed first by the Director of the originating Unit and those with exclusively local implications are handled using the clinical governance arrangements of the provider NHS Trust. Those with possible relevance to other NPIS Units are referred to the NPIS Clinical Standards Group, where details are considered and recommendations for further actions are made. If an urgent issue arises, this can be discussed rapidly between meetings so that urgent actions can be taken when necessary.

 


Critical events

During the 2016/17 reporting year there were 13 critical events reported and discussed nationally. Four of these related to clinical advice provided via TOXBASE; in three of these, no changes to the TOXBASE entry were considered necessary, but one report prompted clarification about the appropriate observation period following recreational use of fentanyl patches. There were four episodes where clinical advice provided by NPIS staff via telephone had been questioned. Investigations indicated that the advice provided was suboptimal in two of these cases; one had resulted in the unnecessary referral of a patient to hospital and in the other unnecessary ECG monitoring had been recommended. In each case, feedback was provided to the staff member involved. Other incidents reported included the use of TOXBASE by an NHS staff member planning a suicide attempt, delay in the delivery of antivenom for exotic snakebite by an external contractor and the issuing of clinical advice by an external agency which implied support from NPIS when this had not been discussed.

 

The remaining two critical incidents were important because they reflect increasing pressures on NPIS staffing resource. In one case telephone advice about a critically ill patient could not be obtained by an emergency department because both out-of-hours telephone lines were being used for other enquiries. In the other, an NPIS Unit was only able to cover one rather than the usual two telephone lines during a weekend shift due to short-term staff sickness. Problems of this type, although rare, are likely to occur with increasing frequency in view of gradual resource-related reductions in NPIS staff numbers. To mitigate the problem, a mechanism by which volunteer staff from other NPIS Units can be asked to provide additional cover at short notice has been organised.

 

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