Guideline for the Out‐of‐Hospital Management of Human Exposures to Minimally Toxic Substances

Guideline Summary

All substances are capable of producing toxicity, so nothing is completely non‐toxic. Minimally toxic substances are those which produce little toxicity, minor self‐limited toxicity, or clinically insignificant effects at most doses. Examples include silica gel, A&D ointment, chalk, lipstick, and non‐camphor lip balms, watercolors, hand dishwashing detergents, non‐salicylate antacids (excluding magnesium or sodium bicarbonate containing products), calamine lotion, clay, crayons, diaper rash creams and ointments, fabric softeners/sheets, glow products, glue (white, arts, and crafts type), household plant food, oral contraceptives, pen ink, pencils, starch/sizing, throat lozenges without local anesthetics, topical antibiotics, topical antifungals, topical steroids, topical steroids with antibiotics, and water‐based paints. Minimally toxic exposures have the following characteristics: (1) The information specialist has confidence in the accuracy of the history obtained and the ability to communicate effectively with the caller. (2) The information specialist has confidence in the identity of the product(s) or substance(s) and a reasonable estimation of the maximum amount involved in the exposure. (3) The risks of adverse reactions or expected effects are acceptable to both the information specialist and the caller based on available medical literature and clinical experience. (4) The exposure does not require a healthcare referral since the potential effects are benign and self‐limited. However, decisions regarding patient disposition should take into account the patient's intent, symptoms, and social environment. In addition, individual patient circumstances (e.g., pregnancy, pre‐existing medical conditions, therapeutic interventions) need to be considered. Minimally toxic exposures may vary in route (dermal, inhalation, ingestion, ocular), chronicity (acute, chronic), and substance composition (single or multi‐ingredient, single or multiple product). Future categorization of substances as “minimally toxic” should be based on a process involving review of current knowledge, a thorough analysis of poisoning experience, and prospective validation.     

Evaluación del triaje realizado por enfermeras en el Servicio de Urgencias del Hospital Clínico Universitario «Lozano Blesa» (Zaragoza)

Objective

To evaluate nurses’ triage quality and adequacy in Saragossa's Hospital Clínico and to compare the main characteristics of “urgent” and “non-urgent” visits to the Hospital Emergency Department (HED).

Impact of revised triage to improve throughput in an ED with limited traditional fast track population

Background

Emergency department (ED) crowding is associated with patient safety concerns, increased patients left without being seen (LWBS), low patient satisfaction, and lost ED revenue. The objective was to measure the impact of a revised triage process on ED throughput.

Is there shared decision making when the provider makes a recommendation?

Objective

To compare the amount of shared decision making in breast cancer surgery interactions when providers do and do not make a treatment recommendation.

Methods

We surveyed breast cancer survivors who were eligible for mastectomy and lumpectomy. Patients reported whether the provider made a recommendation and the recommendation given. They completed items about their interaction including discussion of options, pros, cons, and treatment preference. A total involvement score was calculated with higher scores indicating more shared decision making.

Results

Most patients (85%) reported that their provider made a recommendation. Patients who did not receive a recommendation had higher involvement scores compared to those who did (52% vs. 39.1%, p = 0.004). Type of recommendation was associated with involvement. Patients given different recommendations had the highest total involvement scores followed by those who received mastectomy and lumpectomy recommendations (65.5% vs. 42.5% vs. 33.2%, respectively, p < 0.001).

Conclusion

Providers were less likely to present a balanced view of the options when they gave a recommendation for surgery. Patients who received a recommendation for lumpectomy had the lowest involvement score.

Practice implications

Providers need to discuss both mastectomy and lumpectomy and elicit patients’ goals and treatment preferences regardless of whether or not a recommendation is given.