Oct-Dec, 2011 - Indian Journal of Pharmacy Practice

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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
Shobha C - Poison Information Center-An Overview of its Significance, Organization and FunctioningStep 5: Evaluate and provide the information:The retrieved information should thoroughly and critically beevaluated. Comprehensive information has to be generated toensure the recommended line of management is based on allof the current evidence available. Response should begenerated only after critically evaluating all the informationavailable. However, the consistency of information amongthe resources used should be ensured. Interpretation ofinformation available in various resources should be patientspecific and is made considering all other factors. In case oflack of information or conflict of information in the availablesources, a decision may be taken based on professionalknowledge and previous experience. Information may beprovided either verbally/written/printed form/through fax ore-mail as appropriate. However, timely or immediate deliveryof response is critical. In cases where more time is required toevaluate and formulate the response, minimum vitalinformation is to be provided at the earliest possible time.Step 6: Conduct follow-up:Follow up of case is vital so as to assess the patient outcomeand also to ensure whether provision of any additionalinformation is useful in the management of poisoning.Personal visit may be more useful and is possible only whenthe victim is admitted to the hospital where poisoninformation center exist. In other cases the follow up can bemade through other modes including telephone enquiry and e-mail.Step 7: Document:Document the details of enquirer, query and response in atleast any one modes of documentation (paper, computer, logbook etc) is essential for several reasons. It not only helps inthe future reference for similar repetitive query, but alsojustifies the professional value and acts as protective measureagainst legal liability.Step 8: Maintain confidentiality:All issues relating to query is to be kept confidential by thecenter for the socio-legal reasons. The details of the enquirershould not be disclosed to any one including family membersand health care professionals without the consent of theenquirer.Quality assurance:Quality assurance programmes are essential for the PIC. Aformalized quality assurance programme has to be developedand implemented continually in PIC for the services provided6. The aim of implementing the quality assurance program isto improve the quality of service provided and therebyimprove the patient health outcomes. The quality assuranceprogramme should include performance indicators andevaluation methods for monitoring the quality,appropriateness, timeliness of management or treatmentrecommendation and effectiveness of service. In addition tothese, it also helps in resolving identified problems toimprove patient care in a timely manner. Governing body ofthe PIC should conduct meetings at regular intervals todiscuss and take decision on corrective actions and qualityimprovement strategies regarding complicated enquires/cases, any complaints to PIC, statistics of hospitalised poisoncases, review of management protocols, educationalactivities and prevention of poison cases. As part of qualityimprovement programs, expert opinions from consultantclinical toxicologist may be obtained especially for the callsthat have been referred to clinical toxicologist.CONCLUSIONPIC helps in decreasing the incidences of morbidity andmortality due to poisoning and also reducing the costassociated with management of poisoning. In India, there is aneed for centralized database and expert advice ontoxicological service for assisting the physicians andeducating the public in the prevention and management ofpoisoning cases. This can be achieved by establishment ofseveral regional PICs all over India and the networkingsystem between regional PICs and national poisoninformation center. Since only a few regional PICs exists inIndia there is a need for more number of PICs to provide thevital poison information services for management ofpoisoning.REFERENCES1. Lall S B, Peshin S S. Role and functions of poison informationcentre. Indian J Peadiatr 1997;64:443-9.2. Kranzalok E P. International poison information centre datacollection capabilities. Vet Human Toxcol 1995 Jun;37(3):246-8.3. Laborde A. New roles of poison control centres in thedeveloping countries. Toxicology 2004;198:273-7.4. Sam K G, Rajan M S V, Saghir Z, Kumar P, Rao P. Evaluation ofpoison information services of a clinical pharmacy departmentin a south Indian tertiary care hospital. JCDR 2009 Feb;3:1313-8.5. Ponampalam R, Loh C S. Cost benefits of the Drug and PoisonInformation Centre in preventing unnecessary hospitalisation:the Singapore experience. Hong Kong j.emerg.md 2010;17:45-53.Indian Journal of Pharmacy Practice Volume 4 Issue 4 Oct - Dec, 2011 19
Page 1 and 2: Indian Journal of Pharmacy Practice
Page 3 and 4: Dear ReadersIndian Journal of Pharm
Page 5 and 6: Daxesh M P - Combating Antimicrobia
Page 13 and 14: J. Chang - India's Progress towards
Page 15 and 16: J. Chang - India's Progress towards
Page 17 and 18: Shobha C - Poison Information Cente
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Page 25 and 26: Anantha Naik N -Health Related Qual
Page 33 and 34: Amrita P - Scenario of Pharmacovigi
Page 42 and 43: Satyanarayana V - Evaluation of the
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Anoop P -Impact of Clinical Pharmac
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Singh B -Respiratory Tract Problems
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Singh B -Respiratory Tract Problems
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Mihir Y.P - Study of Prescribing Pa
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Ramanath K.V -Evaluation of the Imp
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Ramanath K.V -Evaluation of the Imp
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Instructions to AuthorsIntroduction
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