TOXINZ success

Developed over the past 50 years, the National Poisons Centre's database, TOXINZ, has been widely used by New Zealand clinicians. Now it is gaining the respect of the international medical profession as well.

The nightmare starts with the screams. Your wailing toddler appears at the kitchen door, coughing and spluttering and still clutching the sweets he's been sampling – but they're not sweets.

It's a scene played out in far too many homes – often around mealtimes – when parents are at their busiest. It takes only seconds for tots to mistake firelighters for marshmallows, or insulation batts for candyfloss, and you are faced with what could be life or death decisions.

What do you do?

Otago's National Poisons Centre's lines are open round the clock and they are probably your best bet, says operations manager Lucy Shieffelbien.

“By the time you have found your car keys and got your child into the car seat, you could have called us and been given the information that you need,” she says. “Some 80 per cent of incidents could be managed at home with the right advice.”

In the case of firelighters, they taste so awful that kids are unlikely to have ingested enough to harm them and batts, although unpleasant if swallowed, are chemically inert, although they could cause an obstruction or blockage.Many other household items are more serious.

“Children will eat the most disgusting things. Under-twos are just exploring with taste, so poisons are not necessarily just chemicals and medicines. They're often everyday things such as dishwashing agents, which are one of the most commonly reported things kids swallow.”

The Poisons Centre's 0800 number gives the public direct access to TOXINZ, a constantly updated database of almost all poisonous substances people are likely to experience, with advice and support from trained health professionals.

It's fast, it's free and it's widely used, with roughly 100 calls a day from the public and from GPs and practice nurses. Many of those calls help reduce the number of people who would otherwise be clogging up hospital emergency departments with minor mishaps. Hospitals have separate access to the database.

The demand is there – and not just in New Zealand.

The TOXINZ database, developed at the University of Otago over the past 50 years, today contains more than 190,000 documents with comprehensive and up-to-date information on poisonous chemicals, pharmaceuticals, plants and animals. It is fully referenced, providing treatment pathways, brand names and combination products, removing the need for clinicians to identify individual ingredients and chemicals. It is also easily navigated and contains images to help with the identification of hazardous plants and animals.

TOXINZ's content is maintained 24 hours a day, seven days a week by poisons information staff, with updates made in real time as new information becomes available.

This database has become so popular that clinicians who had used it here before moving to other countries asked if it could be made available overseas.

“While they had access to other poisons information resources, TOXINZ was their favoured resource,” says Shieffelbien. “This feedback confirmed that TOXINZ is a world-class, gold-standard database with potential.”

Otago Innovation Limited, the University's commercial arm, is realising that potential. In 2009 the database was successfully launched in Australia, where it has been adopted by most Australian states. Last year it received more than 56,000 searches so uptake has been positive.

Otago Innovation Limited CEO Colin Dawson is delighted at the Australian response.

“We're always looking for practical commercial applications for the University of Otago's technology and, right under our noses, was a high quality product already being provided to New Zealanders in the shape of TOXINZ.” – Otago Innovation CEO Colin Dawson.

“It's a safe and trusted professional product developed over decades. It's a perfect fit for what we are doing and we're proud to be associated with it.”

After consolidating Australian distribution, it is planned to launch the database in North America, where it will be distributed by academic publishers. Success in North America may then lead to further global expansion.

Some third-world countries already have access through the World Health Organization's HINARI programme, which provides a wide range of medical and health information free to developing countries.

The National Poisons Centre has come a long way from small beginnings, says director Dr Wayne Temple. It began in 1964 as a joint venture between the University's Department of Pharmacology and the Otago Hospital Board, based at Dunedin Hospital, as an emergency information source for both health professionals and the public in cases of poisoning.

The originally paper-based database of toxic compounds and poisons-management information grew over the years, swelling to more than 200,000 pages. Between 1985 and 1987 this sometimes cumbersome collection of microfilms and manual filing systems became computerised.

The call centre was established in 1990, providing 24-hour assistance by 1995. By 1996, hospitals were getting poisons information on CD ROMs that were updated every six months, although the centre's database was updated weekly. Free calling began in 2001; the web-based TOXINZ – www.toxinz.com – was launched in 2002, with software developments enabling real-time updates on the web from 2004.

Now the centre has 10 poisons information officers – all Otago health science graduates – who train for at least three months before being eased into the job of answering the phones.

Peak hours tend to be around 10 am and 7 pm, when young children are still up and parents are most likely to be distracted by meal times. Summers are busier than winters, as people spend more time outdoors and find more ways of getting themselves into trouble. Christmas and exam times are likely to bring more calls involving overdosing by the lonely and stressed.

Monitoring such trends is vitally important for a living database, says Temple.

“We are constantly maintaining the database, updating to make it as accurate as it can be. We look at new products and look at failed searches to find out why the search items do not appear. We monitor what is being searched for, which gives us our top search hits, and also indicates new products that are coming onto the market.”

The data also show emerging trends. Recent tax increases on cigarettes may be having the desired effect of getting more people to try to quit smoking, but there have been unexpected consequences.

“We've seen a greater incidence of children being poisoned by eating the products that help adults quit smoking,” says Shieffelbien. “They think they might be chewing gum, but they are actually dangerous medicines and need to be kept out of reach of children.”

Temple points out that synthetic cannabinoids are a recurring problem, despite changes in the law. “They cause a lot of problems for hospitals and individuals, and although we liaise with the Ministry of Health to try to control them, legislation always lags behind the problem.”

Monitoring the activity of poison centres – toxicovigilence – can lead to timely alerts through the media for parents and caregivers to be aware of potential problems in new and existing products.

But the same products keep appearing on the list of dangers and they are mainly items found in most homes. Dishwashing agents and common pain relief tablets always feature highly on the list, which means that home management is a vital part of keeping children safe.

But even the most careful families can slip up – so what do you do when you suspect your child may be poisoned?

This is what the experts recommend:

  • If the child stops breathing or is unconscious, call 111 immediately
  • Check the child's mouth to see if there is any remaining matter and clear it away
  • It is okay to give them a small glass of water to drink (but only 1/4 to 1/2 a cup)
  • Never ever make the child vomit (in some cases they may start vomiting as a response to what they have swallowed)
  • Call the National Poisons Centre immediately on 0800 POISON / 0800 764766
  • If you know what they have swallowed, bring the container or packaging to the phone with you
  • For free poison prevention information, visit www.poisons.co.nz
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