Division Overview & Profile:

Drug & Poison Information Center (DPIC)

Jonathan Colvin, DPIC Director of Operations

May 31st, 2018

Mission

• Focused on improving health

outcomes and reducing costs tied to

preventable injury/illness among the

patients, families, and clients we

serve

MVS DPIC

1970s 1980s 1990s 2000s1960s 2010 +

DPIC Founded in 1966

• UC College of Medicine

• Drug Information ONLY

• Service for physicians

1st Industry Partnership

• 1982: Consumer product safety hotline launched

• Enabled 24/7 PCC services

Industry Svs Growth

• Outsourced personnel

• Expanded contact center services including “chat”

Poison Control Services

• 1972: Poison Control & Prevention services PCC services available to the public

Expanded Outreach Services

• Prevention Research Unit emphasizing drug abuse and mental health services

• 1997: DPIC aquired by Cincinnati Children’s

Medical Vigilance Solutions

• MVS Brand launched 2012

• Full service pharmacovigilance & medical communications

Evolution

Safety Hotline

• Occupational Safety

• Patient Safety

DPIC/MVS

Org Restructuring

• 2017: DPIC/MVS budget centers separated & moved under CHRF

CCHMC

• 1997: DPIC moves to CCHMC under strategy & growth

Staffing

DPIC

–Hotline (N=39, 21 FTE)• 1 Medical Director

• 2 Managers (RN)

• 2 Physician Toxicologists

• 3 Pharm-D Toxicologists

• 10 RPh/PharmD Specialists

• 11 Nurse Specialists

• 10 Allied Health Specialists

–Outreach (N=5, 4 FTE)• 1 Manager

• 2 Outreach Specialists

• 2 Community Pharmacists

MVS

–Pharmacovigilance (N=56, 50 FTE)• 3 Managers (RN)

• 4 PharmD Analysts

• 42 RN Specialists

• 7 Data Mgmt. Specialists

–Medical Communications (N=15, 17 FTE)• 1 Manager

• 4 Project Leaders (RPh/RN)

• 1 RPh Specialist

• 7 Nurse Specialists

• 2 Allied Health Specialists

• Quality Manager (N=1)

Drug & Poison Information Center (DPIC)

Overview of Programs & Services

DPIC Services

• Hotline– Poison Control

– Drug Information (Community & Retail)

– Public Health Infectious Disease Reporting

– Safety Hotline

• Clinical– Medical Toxicology Service

– Research, Training & Education

• Community Education & Outreach– Poison Prevention & Awareness

– Drug Abuse Prevention

– Mental Health & Trauma Informed Care

Poison Center Hotline

• 55 regional PCCs serve the entire U.S. population– Accredited by the American Association of Poison Control Centers (AAPCC)

• DPIC serves half of Ohio’s population (Pop 5.8M in 25 counties)– Free medical advice and information via 24/7 national toll free hotline (1-800-222-1222)

– Staffed by physicians, pharmacists, nurses, and allied health specialists (EMTs) with specialized training in toxicology, pharmacology, medical triage, & risk communication

• DPIC handles approximately 350 calls/day– 3:4 calls directly from patients & families

– 1:4 calls from healthcare providers

– 60% of poisonings involve children/teens

Poison Center Hotline Outcomes

• Patients: Accessible and Affordable Health Care– Public services are delivered at no direct cost to our callers

– Triage, assessment and management of poisoning exposures

– Drug information and consultation

– Drug abuse counseling and referral

– Bilingual staff and interpreter services

• Payers: Appropriate health-care utilization– Vast majority (>80%) of exposures are managed outside of healthcare setting (>$50M/year in Ohio)

• $17 saved for every $1.00 invested (cost avoidance is 2nd to vaccinations)

– 1,000 unnecessary ambulance runs averted annually

– Reduced hospital length of stay (2-3 days when DPIC consulted)

– Over 1000 appropriate referrals to CCHMC annually

Poison Center Hotline Outcomes

• Public Health– 24/7 hotline for reportable infectious disease

– Real-time threat detection & response• Product recalls, food poisoning, pesticides

• Medication diversion/contamination

• Hospital & community preparedness

• Improving patient care delivery– Specialized medicine in field of toxicology with evidence-based patient management guidelines

– Medical toxicology consultation available 24/7

– Over 100 residents, PharmD Interns and nursing students trained annually

– Robust data collection used for ongoing research

Current Trends by Age GroupPoison Control Hotline trends

Children (Aged 0-5 years)

• 55% of poisonings involve non-pharmaceuticals– Personal care products (14%)

– Cleaning products (11%)

– Foreign bodies/toys (7%)

– Pesticides (3%)

– Plants (3%)

• 45% involve OTC and Rx meds/supplements– Analgesics (9%)

– Topical preps (5%)

– Vitamins (4%)

– Antihistamines (4%)

– Herbal supplements (4%)

– Gastrointestinal (3%)

– Cough & cold (3%)

In Reach

+ In Sight

Contact

Young Children: Areas of Concern

• High Risk Medications– Opioid/pain, heart, ADHD, diabetes, others

• Look-alike products

• Laundry pods

• Liquid nicotine

• Seasonal– Mushrooms

– Carbon monoxide

• Medical Marijuana

Older Children (aged 6-12 years)

• School-related– Medication errors (school, sibling mix-ups)

• Household products– Mixing chemicals

– Eye exposures

• Flu season– Cough & Cold medications

– Hand sanitizers

• Caffeine beverages

Teens

• Drug abuse, misuse, experimentation– Designer drugs (e.g. synthetic

marijuana)

• Social media Challenges– Tide Pods, Cinnamon, Kylie Jenner,

Spicy Foods, Choking Game, Fire Challenge

• Attempted Suicide– Reports to Ohio PCCs have increased

10-15% per year since 2011

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Teen Attempted Suicide Trends 2007-2017 (Age 13-19 Years)

Adults

• Opioid epidemic

– Designer/synthetic

• Medication Errors (dosing, interactions,

confusion)

– Heart Medications

– Analgesics

– Sedatives (anxiety, psych)

– Hormones (insulin, thyroid)

• Occupational exposures

– Medical marijuana

– Industrial chemicals

– PesticidesSOURCE: National Institute on Drug Abuse, National Institutes of Health, 15SEP2017

Safety HotlineService of the Drug & Poison Information Center

CHMC Safety Hotline

• 24/7 hotline for reporting & responding to safety incidents and concerns– Available to anyone who supports medical center services

– All concerns are valid and supported

Safety Hotline: How Does it Work?

• Simplify & Enable Action– Onus of a complex system is managed by

specialized few

– Immediate access to the right expert 24/7

– Centralized process control &

standardization

• Protocol compliance

• Coordination & Communication

• Documentation

• Situation awareness

• Continuous process improvement

Safety Hotline: Worker’s Comp Benchmarking

• Analysis of 98 OH hospitals

• Weighted by facility size

• 2013-2017 most current study

available

• Key findings

• CCHMC claim frequency &

severity ~8 fold lower than

aggregate mean over 5 years

period

• $11M est. cost savings over 5

year period compared to

expected mean

Safety Hotline: Worker’s Comp Benchmarking

• 2016 claim frequency & severity

• X-axis: WC Claims per 100

FTEs (frequency)

• Y-axis: Total Incurred Costs per

100 FTEs (severity)

• Key finding

• CCHMC claim frequency and

severity was lowest among all

participating hospitals,

regardless of size

Questions?

Medical Vigilance Solutions (MVS)

Overview of Services

Director: Patricia Klein, PharmD, MPH

Core Capabilities

• Experienced PharmD Project

Leaders and Writers

• Standard and custom medical

information responses

• FAQ and standard verbal

response development

• Formulary dossiers

• Expert literature searching,

alerting, and analyses

• Document and knowledge

management systems including

SharePoint and IRMS

• Promotional review and

development

• Scientific exchange slides and

materials

• Training and education

materials

• Medical Science Liaison support

• Abstracts, posters, and

manuscripts

Medical Communications

• Staffed by experienced

pharmacists, nurses, and allied-

health professionals

• Medical Inquiries from

consumers and health care

professionals

• Adverse Event Intake and

Management

• Product Quality Complaint

intake

• Digital call recording

• Comprehensive quality and

compliance monitoring

• Clinical Trial Support

• Live Text Chat

• Metrics driven staffing, call

routing, and service levels

• Validated IRMS database

• Hands-on experience with

industry leading databases

24/7 Contact Center

• PharmD, RPh, RN, Allied Health

professionals, Data Managers

• Global post marketing and

clinical trial adverse event

management

• Medical literature surveillance

• AE Intake, assessment, data

entry, coding, and follow-up

• Regulatory agency reports,

PSURs, PADERs, and

expedited reports

• Data analysis and ad-hoc safety

reports

• Database reconciliation

• MedDRA and WHO Drug coding

• REMS/risk management

services

• Regulatory agency audit support

• Validated safety database

• ARGUS, ArisG Experience

Pharmacovigilance

Questions?