National Poisons Information Service (NPIS)
The National Poisons Information Service (NPIS) is a clinical toxicology service for health care professionals working in the NHS. It is endorsed by the Department of Health and commissioned by the HPA. It provides expert evidence-based advice on all aspects of acute and chronic poisoning, supporting best practice in the diagnosis and management of patients who may have been accidentally or deliberately poisoned, whether by ingestion, injection, inhalation or skin or eye contact.
What services does NPIS provide?
Services provided by NPIS include
- Provision of information on suspected poisoning or exposure to a large range of substances, including
- Medicines
- Drugs of abuse
- Household and industrial chemicals
- Complimentary and alternative medicines
- Tablet identification services
- Location of antidotes
- Location of laboratory assays that may be required in the treatment of poisoning
- Advice on the effects of drug and chemical exposures during pregnancy via the National Teratology Information Service
- Maintaining a registry of data on the composition of consumer products via the Product Data Centre
- Horizon scanning and summary of the current scientific literature about poisoning via the NPIS publication Current Awareness in Clinical Toxicology
- Education for NHS staff about the management of poisoning
- Research about poisoning and clinical toxicology
- Advice to government bodies and other official organisations about poisons-related issues
These services are not for members of the public; NPIS supports NHS Direct (England and Wales) and NHS 24 (Scotland) in providing advice to members of the public (Figure).
How is information provided?
Information on the management of poisoning is provided directly to registered healthcare professionals directly via the internet database TOXBASE, or via our 24 hour telephone advice service for more complex cases requiring specialist advice or when the internet is not available to the enquirer (Figure).
Advice from a consultant clinical toxicologist is always available for cases which are more complex. More details of how consultant staff support NPIS can be found here.
How poisons enquiries are answered
Who provides the services?
NPIS services are provided by a network of units located across the UK. There are currently four NPIS units in:
- Birmingham (www.npis.org/)
- Cardiff
- Edinburgh (http://www.spib.scot.nhs.uk/spibdir.htm)
- Newcastle (www.nyrdtc.nhs.uk/Services/poisons/poisons.html)
These NPIS units are all embedded within NHS teaching hospitals and the consultant staff attached to them also provide specialist clinical toxicology services to their local populations.
NPIS units are staffed by:
-
Specialists in poisons information. These are graduate scientists (biomedical scientists, nurses, pharmacists) with additional training
-
Clinical toxicologists. These are medically qualified staff with a specialist interest in clinical toxicology and poisoning. There are consultant medical staff in each NPIS unit. There may also be specialist registrars attached as part of their training.
What are the responsibilities of individual NPIS units?
Each NPIS unit has a lead responsibility for provision of services in a specific geographic area determined on the basis of medical deanery boundaries. These local services include
- Daytime telephone call handling (Monday to Friday 8am to 8pm). Calls from healthcare professionals in each deanery are routed to the appropriate NPIS unit in the first instance. If all lines are busy the call is passed on to another NPIS unit to ensure a rapid response. Out-of-hours enquiries are handled by the Birmingham, Cardiff, and Newcastle units in rotation, with two units open until 11pm and one unit open overnight.
- Local educational activities
- Provision of local information on antidote holdings and availability of laboratory assays to the NPIS.
In addition, each NPIS unit has other specific responsibilities as shown below.
|
NPIS Unit |
Area of lead responsibility (by deanery) |
Other responsibilities |
|---|---|---|
|
Birmingham |
West Midlands |
Current Awareness in Clinical Toxicology |
|
Cardiff |
Wales |
UKPID |
|
Edinburgh |
Scotland |
TOXBASE |
|
Newcastle |
Northern |
National Teratology
Stakeholder Quality assurance questionnaire |
Northern Ireland is served by the Northern Ireland Regional Medicines and Poison Information Service in Belfast during the daytime and uses the NPIS out of hours.
Calls from Ireland are also handled by NPIS between 10pm and 8am.
How is the service organized nationally?
Although NPIS is provided by units embedded in separate NHS Trusts, a uniform national service is ensured by the following arrangements:
- Each Unit holds a contract for provision of services to HPA. These contracts are in a common format and include key performance indicators.
- All NPIS units work to common national standards as detailed in agreed operational procedures.
- All telephone enquiries are recorded onto the UK Poisons Information Database (UKPID) which is enquiry answering software specifically developed for this purpose. Specific data protection arrangements are in place.
- A number of groups meet regularly to agree national guidance and NPIS policy:
-
The NPIS Clinical Standards Group meets quarterly to develop and finalise clinical advice and discuss clinical governance issues. In addition, the group discuss urgent issues more frequently by teleconference
- The TOXBASE editing group meets quarterly to edit and agree TOXBASE entries
- Joint NPIS Commissioning meetings take place quarterly to discuss NPIS policy issues. In addition, each unit will have at least one formal meeting with commissioners each year to review progress against their contract and to agree a contract and budgets for the subsequent year.
- NPIS Continuing Professional Development meetings take place quarterly, with the location rotating around the NPIS units. These are open to all NPIS staff and have sessions designed for information scientists and for clinicians.
- The UKPID user group meets regularly to discuss issues relating to enquiry logging software.
-
How is the quality of services assured?
The quality of services provided by NPIS is assured by
- appropriate induction, training and assessment of staff
- continuing professional development opportunities
- formal audit of advice provided
- the availability of 24h consultant support
- An annual stakeholder feedback exercise
How can NPIS help with obtaining antidotes?
NPIS does not hold or supply antidotes but provides guidance on appropriate holdings of antidotes by NHS trusts and can provide information on local antidote holdings when necessary.
How can NPIS help with use and locating specialist laboratory assays?
NPIS has issued guidance on appropriate use of laboratory assays for the management of poisoning, in conjunction with the Association of Clinical Biochemists. Health professionals registered with TOXBASE can access this guidance.
How is NPIS funded?
NPIS is funded mainly through ‘Government Grant in Aid’ from the UK Health Departments, some contract income and some research income. The NPIS programme cost £3.5 million in 2005/06. Medical staff costs are 26% of the expenditure, specialists in poisons information (SPIs) 54%, and all other supporting costs 20%.
What information is available on the activity of NPIS?
Details of the activity of NPIS is provided in annual reports available from the Publications area.
What government bodies does NPIS advise?
NPIS units also provide information and advice to the following:
Health Protection Agency
Medicines and Healthcare products Regulatory Agency (MHRA),
Department for Environment Food and Rural Affairs (DEFRA)
Pesticide Safety Directorate(PSD)
Advisory Council on the Misuse of Drugs
Last reviewed: 19 August 2009
- UK National Poisons Information Service 2003-2008 - A Time of Change
Added/updated: 4 February 2010 - National Poisons Information Service (NPIS) Reports
Added/updated: 16 September 2008
