Section 215.APPENDIX A  American Association of Poison Control Centers' Criteria for Certification as a Regional Poison Center

Introduction

The purpose of this document is to establish criteria by which poison centers can be recognized as possessing the qualities needed to adequately serve a significant population.  Poison centers function primarily to provide poison information, telephone management and consultation, collect pertinent data, and deliver professional and public education.  Poison treatment facilities function primarily to provide medical control for pre-hospital emergency medical services and to deliver health care to poisoned patients.  Cooperation between Regional Poison Centers and poison treatment facilities is a key feature of any poison center program and is essential for achieving the ultimate goal of optimal health care for the poisoned patient.

I.  Determination of Region

A.        Geographical characteristics.  A Regional Poison Center may serve a single state, a multi-state area, or only a portion of a state.  The region should be determined by state authorities in conjunction with local health agencies and health care providers.  In instances where multiple states are involved, designation from each state will be necessary.  Documentation of state designations must be in writing and must clearly delineate the region to be served, the services to be provided, and the exclusivity of the designation. In instances where a state declines in writing to designate any poison center, designation by other political or health jurisdictions (e.g., county, health district) may be an acceptable alternative.  In instances where more than one center is designated to serve the same area, evidence of cooperative arrangements must be provided.

B.        Population base.  In the absence of compelling reasons to the contrary, a Regional Poison Center program should serve a population base of no fewer than one million people.  It is unlikely that a single Regional Poison Center could adequately serve more than 10 million people.  The center must provide evidence that it adequately serves its entire region.  In addition, the center must receive at least 10,000 human exposure calls per year.

II.  Regional Poison Information Service

A.        The Regional Poison Center shall provide information 24 hours/day, 365 days/year to both health professionals and the public.  This criterion will be considered to be met if the center has at least one specialist in poison information in the center at all times,  sufficient additional staff to promptly handle the center's incoming calls and the availability of the Medical Director or qualified designee, on-call by telephone, at all times.

B.        The Regional Poison Center shall be readily accessible by telephone from all areas within the region.  This criterion will be considered to be met if the center has a direct incoming telephone system that is extensively publicized throughout the region to both health professionals and the public. The center must maintain sufficient telephone lines to assure ready access.  In the absence of a toll-free system, the center must demonstrate that the lack of a toll-free service is not an impediment to public use of the center.

C.        The Regional Poison Center shall maintain comprehensive poison information resources.  This criterion will be considered to be met if the center maintains:

1.         One or more comprehensive toxicology information resources, immediately available at the central telephone answering site.

2.         Current comprehensive texts covering both general and specific aspects of acute and chronic poisoning management immediately available at the central telephone answering site.

3.         Primary information resources and ready availability of a major medical library.

4.         A list of poison center specialty consultants who are available on an on-call basis (see II.E.5. below).

D.        The Regional Poison Center shall maintain written operational guidelines that provide a consistent approach to evaluation and management of toxic exposures.  This criterion will be considered to be met if the center provides written operational guidelines that include but are not limited to the follow-up of all potentially toxic exposures and appropriate criteria for patient disposition.  These guidelines must be available in the center at all times and must be approved in writing by the Medical Director of the program.

E.         Staff qualifications for the Regional Poison Center.

1.         Medical Director.  The Medical Director shall be board certified or board eligible in medical toxicology.  The Medical Director must have a medical staff appointment at a comprehensive poison treatment facility and must be involved in the management of poisoned patients.  The Medical Director should devote at least 50% of his/her professional activities to toxicology.  In addition to clinical, academic teaching and research activities, the Medical Director must formally commit at least 10 hours per week to poison center operational activities involving staff training, development of medical guidelines and quality assurance activities.

2.         Managing Director.  The Managing Director of a regional poison center must be a registered nurse, pharmacist, physician or hold a degree in a health science discipline.  This individual may also be the Medical Director.  This individual should be certified or eligible for certification by the American Board of Medical Toxicology for physicians or by the American Board of Applied Toxicology for non-physicians.  In the absence of certification, the Managing Director must be able to demonstrate on-going interest and expertise in toxicology as evidenced by publications, research and meeting attendance.  The Managing Director must be able to clearly demonstrate full-time commitment to poison center related activities, including the areas of clinical toxicology, education, research and administration.

3.         Specialists in poison information.  Specialists in poison information must be registered nurses, pharmacists or physicians, or be currently certified by the Association as a specialist in poison information.  Specialists in poison information must be qualified to understand and interpret standard poison information resources and to transmit that information in a logical, concise, and understandable way to both health professionals and the public. All specialists in poison information must complete a training program approved by the Medical Director and must be certified by the Association as a specialist in poison information within two examination administrations of their initial eligibility for the certification process.  Specialists in poison information must spend an annual average of 16 hours per week in poison center related activities, including providing telephone consultation, teaching, or public education, or in poison center operations.  All specialists in poison information, whether full-time or part-time, must be 100% dedicated to poison center activities during periods when they are assigned to the center.

4.         Poison center specialty consultants.  Poison center specialty consultants should be qualified by training or experience to provide sophisticated toxicology or patient care information in their area(s) of expertise.  These consultants should be available on-call, with an expressed commitment to provide consultation services on an on-call, as needed basis. The list of consultants should reflect the type of poisonings encountered in the region.

5.         Administrative staff.  Poison center administrative personnel should be qualified by training and/or experience to supervise finances, operations, personnel, data analysis, and other administrative functions of the poison center.

6.         Education staff.

a.         Professional education.  Professional education personnel should be qualified by training or experience to provide quality professional education lectures or materials to health professionals.  This role will be supervised by the Medical Director.

b.         Public education.  Public education personnel should be qualified by training or experience to provide public-oriented poison center awareness, poison prevention and first aid for poisoning presentations.  They must be capable of providing verbal presentations to public audiences, and have sufficient understanding of the material to accurately answer public questions. They may be full-time, part-time or volunteer staff.

F.         The Regional Poison Center shall have an ongoing quality assurance program.  This criterion will be considered to be met if the center has regularly scheduled staff inservices, morbidity and mortality conferences, case reviews and audits (such as chart, process or outcome audits).

III.  Regional Treatment Capabilities

A.        The Regional Poison Center shall identify the treatment capabilities of the treatment facilities of the region.  As a minimum, Regional Poison Centers shall identify analytical toxicology, emergency and critical care, and extracorporeal capabilities within the region for adults and children.

B.        The Regional Poison Center should have a working relationship with all poison treatment facilities in its region.

C.        The Regional Poison Center should understand the analytical toxicology services in its region and how to interface with them.

D.        The Regional Poison Center should understand how the region's prehospital transportation system is structured and how to interface with it.

IV.  Regional Data Collection System

A.        The Regional Poison Center shall keep records of all cases handled by the center in a form that is acceptable as a medical record.  This criterion will be considered to be met if the center completes a record that contains data elements and sufficient narrative to allow for peer review and medical and/or legal audit, and such records are kept on file in compliance with standards for hospital recordkeeping in the region.

B.        The Regional Poison Center shall submit all its human exposure data to the Association's National Data Collection System meeting specified submission deadlines and quality requirements and including all required data elements.

C.        The Regional Poison Center shall tabulate its experience for regional program evaluation on at least an annual basis.  This criterion will be considered to be met if the center completes an annual report summarizing its own experience.

V.  Professional and Public Education Programs

A.        The Regional Poison Center shall provide information on the management of poisoning to the health professionals throughout the region who care for poisoned patients.  This criterion will be considered to be met if the center continually offers information about poison center services/availability and updates on new and important advances in poisoning management to the health professionals throughout the region.

B.        The Regional Poison Center shall provide a public education program aimed at educating both children and adults about poisoning dangers and other necessary concepts related to poison control.  This criterion will be considered to be met if the center continually offers through lectures, public media (newspapers, radio, television), printed educational materials, or through other instructional modalities, information describing the following:

1.         Services and availability of the poison center.

2.         Poison prevention measures.

3.         First aid measures for poisoning management.

            This information must be offered to all parts of the region.

VI.  Association Membership

The applicant center must be an institutional member in good standing of the American Association of Poison Control Centers.