Oct-Dec, 2011 - Indian Journal of Pharmacy Practice

Shobha C - Poison Information Center-An Overview of its Significance, Organization and FunctioningTraining of staff:Adequate training to PIC staff is essential especially for14,15newly recruited and inexperienced staff. PIC shoulddevelop and implement need based staff training manual. Thiswould enable the PIC to train the new and inexperienced staffof PIC in various areas and ensure that the uniformity in stafftraining is maintained. Training components may includeupdation of knowledge in clinical toxicology, communicationskills, handling of databases, retrieval of information,interpretation & analytical skills, handling of equipmentssuch as computers, telephones and other instruments.Handling of poison information query:The ultimate responsibility of the poison informationspecialist is handling the poison information query. To handlethe query, poison information specialist should have goodskills in communicating clearly and concisely to presentexplanatory or interpretive information. It is necessary toestablish and maintain effective working relationships withother employees of organisations and public in emergencyand other situations. Poison information specialist shouldadopt the skill of reacting calmly and effectively inemergency and stressful situation.Identifying those exposures that are potentially serious andrequire immediate medical assessment and those thatrepresent a minimal risk of toxicity can greatly aid in effectivemanagement of poisoning. By identifying exposures thatrepresent a minimal risk of toxicity, unnecessarypresentations to doctors and hospital emergency departmentscan be avoided. Poison information specialist must assesseach call carefully by listening to the caller and asking openendedquestions. Often the information provided by the calleris insufficient to give an accurate answer; in such cases furthertargeted questions should be asked. The poison informationspecialist taking the call must make a decision based on theinformation given by the caller, an assessment of thereliability of the history, their own clinical judgment and theinformation retrieved from the available sources. If anycomplicated query for which information is not available orthe enquirer is not satisfied with the information provided,then poison information specialist should contact/transfer thecall either to the manager/ director or consultant clinicaltoxicologist and seek their expert advice. Following are thesteps to approach poison information query.Step 1: Receive and obtain requester's demographics:Receive and accept the query related to the service either overphone or in person. Establish the identity of the enquirer bygathering contact details. Also obtain all required informationfrom requester that will help to reply the query. If the enquireris a healthcare professional, the position and anticipatedknowledge of the enquirer should be determined. In caseswhere it takes time to obtain information, ask the enquirer tocall back or note their contact number. Query related topotentially serious poisoning cases need to be answeredimmediately and for a query with minimal toxicityappropriate deadline for a response should be established.Step 2: Collect background information:It is important to collect all the required backgroundinformation to provide appropriate information. Obtainingrelevant information often requires targeted questioning, andadditional care is necessary to accurately identify thepoisoning substance. However, all critical information shouldbe obtained in short time to maximize the patient outcome asotherwise it may be counter productive. Basic informationthat required to be obtained include age and/or weight ofvictim, substance/ product name, route of contact (ingestion,inhaled, dermal, ocular), quantity and/or strength involved,time since exposure, patient's condition (signs, symptomsetc.), treatment received and health status of patient includingmedication history, allergies, relevant pre-existingconditions.Step 3: Assessment of the condition:Appropriate background information allows in understandingthe actual query to be responded. Firstly, the urgency of thesituation is to be assessed in terms of whether the condition isan emergency, serious, not serious or no problem. Assess thelikelihood of toxicity associated with the exposed toxinsbased on the nature of substance, type of exposure andquantity consumed. Assessment of signs and symptoms oftoxicity and analytical testing of compound may greatly aid indetermining the appropriate patient management whetherfirst aid, observation, medical treatment, home treatment orno treatment required for that particular condition.Step 4: Develop and conduct a search strategySelect and prioritise the information resources based onprobability of locating the desired information. It is ideal tolocate the information based on the probable efficiency ofinformation sources in the literature hierarchy. Although inmany instances the information can be provided with the useof tertiary resource, it is worthwhile to consider the otherinformation sources as appropriate. Searching informationfrom databases like Poisindex, Hypertox and Intox mayenable the poison information specialist in retrieving thecomprehensive information in short time. In addition, use ofdeveloped poison management protocols may serve as aready reference especially in emergency situation. Theinformation resources used should be documented on thebasis of its usefulness in responding to a query.Indian Journal of Pharmacy Practice Volume 4 Issue 4 Oct - Dec, 2011 18