The Emerging Role of the Pharmacist in Managing Poisoning Cases: A Systematic Review

Purpose: In 2019, a total of 2,573,180 calls were made to poison control centers across the United States. This equates to 1 exposure every 15 seconds, and of the top 10 agents reported in exposures, 5 were pharmaceutical products or prescription medications. This presents the question, what went wrong in these cases? While many poisoning exposures are accidental, some can be attributed to either a lack of knowledge regarding the proper use of the product or improper storage. With prescription medications listed among the top agents, there is a growing need for pharmacists to prevent, and treat poison exposures. The objective of this study was to review the literature and assess the role of the pharmacist in managing poisoning cases. This review aimed to analyze the pharmacist's specific role, associated duties, and necessary skills. A secondary objective was to analyze the literature for common practice sites of pharmacists and describe barriers to participation in poisoning cases. Methods: A systematic review of the current literature was performed using PubMed and SCOPUS. The search included a combination of terms "pharmacist" and "poisonings." Articles dated 2000 to 2020 were included to reflect most current practice. Articles were excluded if they were not from the U.S., not directly related to poisonings, or if the full text was unavailable. Search results from each database were exported to Microsoft Excel and sorted for removal of duplicate citations. Articles were graded on the Oxford scale based on study design and quality of evidence. Data reported from each article was categorized by: study objective, intervention, practice site, pharmacists' role, and skills needed. Additionally, barriers or challenges to pharmacist participation in poisoning cases were documented. Results: The search results from PubMed using search terms 'pharmacist' and 'poisonings' yielded 462 articles. The same search terms in SCOPUS yielded 287 articles, after duplicates were removed there was a total of 666 articles. Records were screened and 591 were excluded with 74 remaining to be assessed for full-text eligibility. Ultimately, 36 full-text articles were assessed and utilized. Article types included retrospective analyses, editorials, surveys, and case reports. When examining the literature for the role of the pharmacist; collaboration and education were the most frequently documented roles. Further specified roles included knowledge of antidotes, supportive care, patient presentation of common poisonings, protocol development, and program implementation. Common practice sites included: Poison Control Centers, hospitals, and community settings. Many articles presented opportunities for pharmacists to intervene however, pharmacists must overcome barriers and challenges. These included but were not limited to: lack of toxicology training, limited pharmacist involvement on the healthcare team, and no documentation of interventions. Conclusions: As drug therapy experts and one of the most accessible healthcare providers, pharmacists can serve a vital role on the healthcare team. Through toxicology training and collaboration with other providers, pharmacists can aid in the treatment of these cases, and in preventing future exposures. In the future, pharmacists should be included in the care and management of poisoning cases.