Tenn. Comp. R. & Regs. 1200-11-06-.04 - REGIONAL POISON INFORMATION SERVICE

(1) The regional poison control center shall provide information 24 hours per day on a 365 days per year basis 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 (at least 95% of calls get through to the center and are answered within five rings) and has the availability of the medical director or qualified designee, on-call by telephone, at all times.

(2) The regional poison control center shall be readily accessible by telephone from all areas within the region. The 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 demonstrate that it provides easy access for the general public and health professionals who reside anywhere in the region.

(3) The regional poison control center shall maintain comprehensive poison information resources. This criterion will be considered to be met if the center maintains:

(a) One or more up-to-date comprehensive toxicology information resources, immediately available at the central telephone answering site. (Preferably, the center should have access to a generally-accepted, computerized data base(s));

(b) Current comprehensive texts covering both general and specific aspects of acute and chronic poisoning management immediately available at the central telephone answering site;

(c) Primary information resources and ready availability of a medical library; and,

(d) A list of poison control center specialty consultants who are available on an on-call basis [(See 1200-116-.04(5)(e) below)].

(4) The regional poison control center shall maintain written operational guidelines which 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 which 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. The poison control center shall maintain a current and easily accessible list of phone numbers of each of the hospitals and pre-hospital transportation systems in the region.

(5) Staff Qualifications and Responsibilities for the Regional Poison Control Center:

(a) Medical Director. The medical director should be board certified in internal medicine, pediatrics, family medicine or emergency medicine or, alternatively, be board eligible or board prepared in one of these medical specialties and actively working toward certification. The medical director must be a properly licensed physician in the state of Tennessee and be able to demonstrate ongoing interest and expertise in toxicology as evidenced by publications, research and meeting attendance. The medical director must have an active medical staff appointment at a general or pediatric hospital. The medical director should devote at least an average of 25%, or a minimum of 10 hours per week, of his/her professional activities to toxicology. In addition to clinical, academic teaching and research activities, the medical director must formally commit at least an average of 8 hours per week to poison control center operational activities, involving staff training, development of poison case management guidelines and quality assurance activities.

(b) Managing director. The managing director of a regional poison control 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 The managing director must be a properly licensed health professional in the state of Tennessee who must be able to demonstrate an ongoing commitment to poison control center related activities, including the areas of clinical toxicology, education, research and administration. The managing director should devote an average of 50%, or a minimum of 20 hours per week, to poison control center operational activities.

(c) Specialists in poison information. Specialists in poison information must be physicians, physician assistants, registered nurses or pharmacists who are properly licensed in the state of Tennessee. 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 that meets a minimum level of information and knowledge in the areas of

1. Telephone strategy-clinical history, physical assessment, and toxicology assessment skills and information;

2. Information resource evaluation and utilization;

3. First aid for poison emergencies;

4. Triage and medical referral procedures;

5. Psycho-social assessment and verbal communication skill development;

6. Inter-agency referral and consultation procedures;

7. Case documentation;

8. Follow-up and ongoing assessment; and,

9. Product and substance toxicology information and treatment guidelines as determined by the medical director Specialists in poison information must spend a minimum annual average of 8 hours per week in poison control center related activities, including providing telephone consultation, teaching, public education, or in poison center operations. The primary responsibility of all specialists in poison information, whether full-time or part-time, must be the provision of poison prevention or intervention information. At the approval and discretion of the medical director, a poison information specialist may be assigned other responsibilities but not to such a degree or extent that would interfere or deny appropriate service for poison calls.

(d) Other poison information providers. Other poison information providers must be qualified to understand and interpret standard poison information resources and to transmit that information understandably to both health professionals and the public under the direct supervision of a specialist in poison information or the medical director. This requirement will be considered to be met if the person has an appropriate health-oriented background and has specific training or experience in poison information sciences which include, at a minimum, the following areas of expertise:

1. Telephone strategy-clinical history and physical assessment and toxicology assessment skills and information;

2. Information resource retrieval and evaluation;

3. First aid for non-life threatening poison emergencies;

4. Triage procedures;

5. Verbal communication skill development;

6. Initial case documentation;

7. Case follow-up and documentation;

8. Other topics as deemed appropriate by the medical director.

(e) Poison control center specialty consultants. Poison control 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 as needed basis. The list of consultants, which should reflect the type of poisonings encountered in the region, should consist of a minimum core group composed of the following specialties:

1. Emergency Medicine, pediatric and adult;

2. Mycology;

3. Botany;

4. Veterinary Medicine;

5. Herpetology;

6. Forensic Medicine;

7. Medical Toxicology;

8. Hazardous Materials;

9. Geriatrics;

10. General Medicine, pediatric and adult; and

11. Clinical Pharmacy

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

(g) Education Staff.

1. Professional education. Professional education personnel should be available to provide quality professional education lectures or materials to health professionals. This role will be supervised by the medical director.

2. Public education. Public education personnel should be available to provide public-oriented poison center awareness, poison prevention and first aid for poisoning presentations. They must be capable of providing 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.

(h) The regional poison control center should assure that all specialists and other poison information providers participate in and complete at least 8 hours of continuing education per year as approved by the medical director which is directly relevant to the activities of the poison control center.

(6) The regional poison control center shall have an ongoing quality assurance program. This criterion will be considered to be met if the center has regularly scheduled staff inservices (at least quarterly), mortality chart review, call audits, peer review for documentation and appropriateness of care, audits for outcome and process indicators, demographics including call penetrance, and process review including call volume per specialist, calls placed on hold or interrupted and calls not answered within five rings.

Notes

Tenn. Comp. R. & Regs. 1200-11-06-.04

Original rule filed June 22, 1994; effective September 5, 1994.

Authority: T.C.A. §§ 4-5-202, 68-1-103, 68-141-101, 68-141-102 and 68-141-104.