5 TOXICOVIGILANCE AND PREVENTION
5.7 REQUIREMENTS FOR TOXICOVIGILANCE AND PREVENTION
5.7 REQUIREMENTS FOR TOXICOVIGILANCE AND
The practicality of these methods depends on the number of calls handled by the poison centre. These methods are likely to be less efficient and more prone to error and human bias than automated systems.
Once a signal or emerging trend has been validated by the poison centre, appropriate stakeholders should be notified and the data used in a dynamic risk assessment. As mentioned above, a procedure should be in place to determine when and how an event is to be notified.
5.7.4 SETTING UP AN ELECTRONIC SURVEILLANCE SYSTEM
The availability of electronic records facilitates the storage, handling and rapid analysis of poison centre data and use of electronic-based surveillance techniques. Such surveillance systems should cover a large reference period so that expected rates can be established and secular trends and seasonal patterns in exposure and exposure risks can be identified. Surveillance analyses can be performed statistically or heuristically, and subject matter experts can aid in interpreting the results. Ideally, poison centre data should be securely housed in a centralized location on a platform that allows ready access by authorized users, frequent reporting and data upload capability.
Such a platform requires significant investment for development and maintenance.
The development, operation and maintenance of a poisons surveillance system require a multidisciplinary team of subject matter experts, such as poisons information specialists, medical toxicologists, epidemiologists and IT and systems development personnel. The group should have relevant expertise in toxicology and epidemiology to design, revise or refine case definitions. With these case definitions, epidemiologists can develop signal detection algorithms to scan poison centre data continuously and generate automated notification responses to the surveillance team for validation. During validation, an epidemiologist evaluates the identified signals for data quality, correctness and consistency. Subject matter experts then evaluate the identified signals for clinical relevance and potential impact before notifying the relevant authorities. Examples of surveillance systems in operation in selected countries are given in Annex 4.
5.7.5 DATA GOVERNANCE
Data governance is important to ensure responsible, ethical use of poison centre data for toxicovigilance and surveillance. It may be necessary to establish a committee or steering group for this purpose. Members should include representatives of contributing poison centres, custodians of the central repository and data users (as required). The committee could oversee the development and maintenance of privacy assessments and information-sharing agreements, manage requests for data and disclosure, mediate the information flow from poison centres to end users and maintain privacy and protocols for security breaches.
5.7.6 STAFF
A poison centre should have not only well-trained poisons information specialists but also staff with other skills for a full-scale programme of toxicovigilance and prevention. They include staff with epidemiological and biostatistical knowledge or timely access to such experts to assess cases in the context of underlying patterns and limitations of the data and to determine whether cases should be reported to public health partners. Staff trained in risk communication, health promotion, media communication and the use of social media will enhance the poison centre’s capacity for toxicovigilance and prevention.
Other specialists who can contribute to toxicovigilance and poisons prevention include:
• health educators, to design programmes, communicate with the mass media and ensure effective, continuous distribution of educational material;
• primary health workers, to promote prevention in communities;
• psychiatrists, to evaluate the incidence and severity of certain types of poisoning (such as suicide attempts) to determine possibilities for preventing or minimizing them;
• social workers, to evaluate social conditions that might determine some types of poisoning and to advise on getting clear messages to target populations;
• experimental toxicologists, to conduct studies to confirm or refute apparent links between newly identified hazards and clinical effects and to determine mechanisms of toxicity;
• IT specialists, to initiate and improve electronic capture, integration and analysis of data (if electronic systems are available); and
• toxicovigilance network partners.
Toxicovigilance and poisoning prevention programmes also require adequate administrative and secretarial personnel.
The director of the poison centre should be familiar with the concepts and implementation of toxicovigilance and prevention, supervise the analysis of data and ensure that the relevant authorities are informed about identified toxicological hazards. The director should also ensure funding for prevention activities, for example, for publication of brochures or posters and for campaigns.
5.7.7 TRAINING
Eliciting a complete, accurate history from a caller is a skill that should be addressed in training, and this is described in detail in section 10. Ensuring that poisons information specialists understand the importance and value of data quality for toxicovigilance may help to ensure that they collect and code data to a high standard.
When there are several poison centres in a country, standardized training might help to improve data quality and comparability. Additional training might be required for poisons information specialists (for example, in epidemiology and statistics) to support toxicovigilance activities.
All front-line staff at a poison centre should be trained in reporting cases that might signal an emerging hazard, outbreak or other event of public health significance. Training can be based on a standard operating procedure to ensure that the process is followed correctly. More advanced training may be required to prepare for large- scale public health emergencies that require rapid deployment of several agencies, as described in section 6.
Staff should be familiar with legislation and regulations on the safety of chemical products and pharmaceuticals and of local toxicological problems, for example relating to environmental contamination or use of psychoactive substances. Training should also include dealing with the public, the mass media and professionals in other fields in order to communicate prevention messages.
5.7.8 DOCUMENTS AND FACILITIES
Section 2 describes the documentary resources and physical facilities that a poison centre requires to operate to a good standard. Some additional resources useful for toxicovigilance and prevention activities are:
• up-to-date lists of contacts, protocols and procedures to share information and for joint assessments, coordinated management of events and general collaboration among stakeholders;
• reports of surveys and monitoring by other poison centres;
• an established programme and resources for the production and distribution of educational and instructional materials (brochures, leaflets, posters, slides, videos, websites, mobile apps); and
• educational material produced by other poison centres.
Increased use of social media and virtual forums to share information on the misuse of medications and on substances of abuse make them useful sources for new and developing trends. Poison centre staff should therefore develop expertise in the use and analysis of these media. Automatic approaches, such as supervised classification and natural language processing, hold promise for future monitoring and interventions (27).