Safety and effectiveness of nurse telephone consultation in out of hours primary care

Abstract

Editor-Harkin et al reported the death of a young child in Dublin caused by methadone stored in a baby's bottle. 1 They rightly encourage the routine supply of measuring devices with methadone prescriptions, although perhaps a more appropriate arrangement in families with young children might be ongoing supervised administration within a pharmacy, which may also reduce the opportunity for resale of the drug among drug misusers. Such tragedies are not new. 2 During 1998, among 315 children admitted for observation and treatment for poisoning to the Royal Hospital for Sick Children in Glasgow, 22 had been poisoned with illicit drugs or methadone (table). All came from the local area. They included 11 preschool children who had accidentally ingested drugs, usually within the home. Methadone played a part in three of these 11 cases, although none was related to storage in feeding bottles. Some of these children were seriously ill, and one required intensive care. A further 11 children of school age were admitted over the same period, primarily poisoned by illicit drugs during experimental use or in the context of major psychosocial problems. These events, together with comparatively common accidental needlestick injuries seen after exposure to discarded injecting equipment, highlight the risks run by young children living in households or environments where illegal drugs or their substitutes are used. They represent an additional issue to be considered in supervising and protecting children in such families. Jack Beattie Consultant paediatrician-emergency medicine Royal Hospital for Sick Children, Glasgow G3 8SJ 1 Harkin K, Quinn C, Bradley F. Storing methadone in babies' bottles puts young children at risk [letter].

British out‐of‐hours primary and community care: a review of the literature

“…One efficiency issue that often attracts criticism, as noted earlier, is duplication. For example, Tanna (1999) said that 50 per cent of calls taken by a nurse were also referred to a GP. It is accepted that outcomes are likely to be better since diagnosis, treatment and care are determined by two independent sources.…”