The structure of the PIC allows for variation in tasks and career progression. The Department is made up with a a Department head and deputy as well as 4 senior SPI positions with additional responsibilities. These include education and training, research, standards and toxicovigilance.

All SPIs are provided many opportunities for continuing education specific to poisoning including attendance at domestic and international toxicology conferences. Bimonthly training days are held by the PIC with input from the medical director, Clinical Toxicologists, other health professionals and SPIs. 

Pharmacists practicing in both hospital and community develop a range of skills which are essential in the work of a SPI:

• As well as a sound knowledge in pharmacology and pharmacokinetics, an SPI needs to be able to take an accurate history quickly.
• They need to be familiar with many of the medications and household products about which the caller is enquiring and have excellent communication skills.
• The demands of the role also require patience and a degree of resilience to cope with the prevalence of self-harm and sometimes distressed callers. 

Although call taking at the PIC is individual all shifts worked are with another SPI. The support and collaboration amongst the small and specialised group develops a great sense of teamwork. Working as a SPI is very rewarding both professionally and personally. Callers are genuinely grateful for advice and assistance and very open in expressing that gratitude. The variety of different calls and the sometimes complex nature of the calls ensure a SPI is required to face new challenges daily and is continually learning from these situations. 

To become an SPI, candidates must have a pharmacy degree. Specific training in poisoning and toxicology is provided by the PIC over several months. 

• Assessment questions must be completed for each of the topics before a potential SPI will start some monitored call taking under the supervision of a senior SPI.
• Once confident in call taking the candidate will sit a formal written exam, after passing this they can be rostered to take calls.
• For the first 3 months they would always be rostered alongside another experienced call taking SPI.
• After gaining this experience they must pass a second written assessment before being deemed competent to work all the required shifts, including overnight shifts.

Working at the NSW PIC involves call taking for 8 hour shifts in a rotating 24 hour roster on a 4-week cycle. These shifts are scheduled at the following times:
A. 0545-1400
B. 0800-1600
C. 1400-2200
D. 1600-0000
E. 2200-0600
X. 2000-0000 (4 hour shift)

The shift work associated with working at the PIC is unusual in the world of pharmacy. For many, it offers a level of flexibility useful when managing family and childcare or when working part-time elsewhere. 

• Weekday shifts starting outside of 6-10am attract penalty rates of 10-15%
• Saturdays 50% penalty
• Sundays 75% penalty
• Public holidays 150%.

The staff members currently at the PIC come from a variety of backgrounds in pharmacy including community and hospital pharmacy, research, industry, medical information and regulatory authorities.

Calls involve a range of scenarios including:

• Accidental ingestion by a toddlers
• Deliberate overdoses
• Therapeutic errors in administration of medications
• Drug information including dosages, interactions, usage during pregnancy and breastfeeding
• Adverse reactions
• Illicit drug toxicity
• Occupational exposures
• Bites and stings 

Examples of some calls received by a SPI could include:
1. A Doctor from an emergency department calling about a 20 year old woman who took 24 tablets of Panadol 2 hours ago.
2. Dad calling about his 2 year old daughter who swallowed some dishwasher powder.
3. Carer from a group home has given a client another client’s medication in error.
4. Doctor calling about an 8 year old who was bitten by a brown snake and is bleeding.
5. Farmer calling who has accidentally injected himself in the hand while vaccinating sheep.
6. GP calling from a rural hospital with an unconscious 38 year old female who has taken unknown quantities of imipramine, tramadol, temazepam and alcohol.

Information collected while taking calls must also be recorded accurately in a database to create a medical record for each call. This must be completed in a timely manner with each SPI taking an average of 60-70 calls in an 8 hour shift. Each SPI must also check the call records of each call taken on the shift prior to theirs for accuracy and peer review. 

A SPI has access to a number of specialist databases to source information which will assist with making the risk assessment and provide appropriate advice. These include:

• Therapeutic Guidelines – Toxicology and Toxinology
• POISINDEX (part of Micromedex)
• Toxinz
• National Poisons Register (NPR)
• ChemAlert
• Internal protocols and guidelines

For complex, serious and life threatening calls the SPI has access to a network of on-call toxicologists who are able to take calls and provide advice when needed. These toxicologists are generally Emergency Physicians or Clinical Pharmacologists working in tertiary hospitals that have completed further study and training in clinical toxicology. Approximately 2% of calls to the NSW PIC each year are referred to a consultant toxicologist.