A ten-step quality assurance program for regional poison information centers.

Our regional poison information center (RPIC) has developed and implemented an ongoing quality assurance (QA) initiative, using performance indicators and evaluation thresholds to permit a planned and systematic process for monitoring the quality, appropriateness and effectiveness of service. A 10-step QA plan was designed that included delineating the scope of care, identifying the most important aspects of care, identifying indicators and thresholds to monitor performance and outcomes, and establishing a formal medical audit review process to resolve questions and/or problems. This QA program has resulted in verification of the validity of the RPIC's data and services. Threshold indicators (the incidence of accidental poisoning in children less than 6 y, incidence of intentional poisoning among children less than 18 y, appropriateness of home versus hospital management, and reduction in major/mortal outcomes in children less than 6 y) have all been successfully met during the past 12 mo. A medical audit committee objectively reviews and meets to discuss all unique poison exposures or those suffering major/mortal outcomes. Examples of identified problems include the lack of utilizing standard abbreviations during documentation and the need to standardize indications for consulting medical back-up. RPICs are innovative health services with unique and increasing responsibilities and liabilities. A QA program, designed to objectively and systematically monitor and evaluate the quality and appropriateness of care rendered the poisoned patient, can improve care and resolve identified problems in a timely manner. A formalized QA program is essential for all RPICs.