UK NATIONAL POISONS INFORMATION SERVICE

The National Poisons Information Service (NPIS) comprises six Poisons Centres (Belfast, Birmingham, Cardiff, Edinburgh, London and Newcastle) providing a year-round 24-hour a day service, for health care staff, on the diagnosis, treatment and management of patients who may have been poisoned. Currently the great majority of enquiries are by telephone to the NPIS Centres. Following a fundamental review of the service, new arrangements have been introduced aimed at:

	moving away from the telephone as the first point of contact for poisons information to the use of the online TOXBASE database supported by a second tier consultant-led information service for more complex clinical advice;
	moving to a "regionally based" service with stronger local links to promote interaction with users of the service - with a single national telephone number system routing calls to the Centre serving the "region" in which a call originated;

New arrangements for the provision of information about poisons and the management of poisonings have been introduced as part of the modernisation of the National Poisons Information Service (NPIS).

The new arrangements will provide a modern, more responsive service giving quicker access to routine information and less congested access to specialist advice. In future, to achieve maximum benefit of the new arrangements and to reflect best practice, A&E departments, General Practitioners and other users of the NPIS should:

	have the necessary equipment to enable use of TOXBASE on the Internet/NHS web, as the primary source of information about actual or suspected cases of poisoning;
	replace any local protocols which require telephone enquiries to be made to the National Poisons Information Service in every case of actual or suspected poisoning with protocols requiring access to TOXBASE for all routine cases;
	generally use the NPIS telephone information service for poisons information necessary for the diagnosis, treatment and management of cases which are clinically more complex.

TOXBASE

TOXBASE is the primary clinical toxicology database of the NPIS. All NPIS Centres contribute to and authenticate the content of TOXBASE and there should be no doubt that it represents the most authoritative source of information available. It should be used by all medical practitioners and other health care professionals working in the NHS as the primary source of poisons information. The TOXBASE database, which has been available on-line for several years via a Viewdata system to registered users, provides information about routine diagnosis, treatment and management of patients suffering from exposure to a wide range of substances and products.

An updated version of TOXBASE is now available to registered users on the Internet.  New users can register through the website. This website is a temporary development site; TOXBASE will be moved to a new permanent address on the Internet/NHS web. Users will need to have computer equipment with an Internet/NHS web connection. It may be possible to make TOXBASE available in CD-ROM format for a limited period where an Internet connection is impossible. Contact your Local Centre about the CD-ROM version, but remember that the online version of TOXBASE will be continually updated, which will not be possible with a CD-ROM.

TOXBASE offers ample information to assist with the proper treatment and management of the majority of cases and should be the first point of reference in all cases of poisoning. Local protocols which require a telephone call to the NPIS in all cases of poisoning or overdoses should be replaced with a requirement to access TOXBASE. The details of each enquiry can be printed out from the website to provide clear information and advice which can then be appended to the patient's medical record.

During the next year, TOXBASE will be enhanced to provide faster access to up-dated, user-friendly information appropriate for the clinical environment through the Internet/NHS web. It is planned that this enhanced version of TOXBASE will be available by October 2000. In the meantime, NHS Trusts with A&E departments and GP practices should begin using the version now available on the Internet.


NPIS Centres

The six NPIS Centres will continue to offer more specialised information to assist with the treatment and management of cases which are clinically more complex. They will also focus on the training of health professionals working within the NHS in the management of poisonings and overdoses, and in the use of appropriate information sources to help deal with cases. To facilitate contact with NHS hospitals and GP practices and the delivery of training and educational programmes, the NPIS Centres are now set up on a regional basis, (see map below), to promote better dialogue with users of the service. The NPIS Centres will be contacting A&E departments and NHS Trusts within their regions with regard to local training programmes. NHS Trusts are asked to fully support these initiatives.

Regions served by NPIS Centres

The regions served by the NPIS Centres are set out below. The regions for those Centres serving England have been determined on the basis of the medical deanery boundaries.