Poison information centre

The number of chemicals, poisonous household products and medicines on the Indian market it is increasing day by day which can frequently increases the risk of misuse of these products and leads to Greater incidence of intentional and unintentional poisoning.

1. POISON INFORMATION CENTRE (PIC) ORGANISATION AND INFORMATION RESOURCES PRESENTED BY: Dr. S P SRINIVAS NAYAK, Assistant professor, SUCP

2. SULTAN UL ULOOM COLLEGE OF PHARMACY 2 INFORMATION CENTRE SUCP HYDERABAD

3. INTRODUCTION The number of chemicals, poisonous household products and medicines on the Indian market it is increasing day by day which can frequently increases the risk of misuse of these products and leads to Greater incidence of intentional and unintentional poisoning. SULTAN UL ULOOM COLLEGE OF PHARMACY 3

4. Poison information (PI) Definition: It is a specialised area of drug information which includes information about the toxic effects of chemicals and pesticides, hazardous material spills, household products, overdose of therapeutic medicines, plants including mushrooms, animal toxins from the bites of snakes, spiders and other venomous creatures and Stings. Functions: Provision of toxicological information and advise Management of poisoning cases Provision of laboratory analytical services Toxicovigilance activities Research education and training in the prevention &treatment of poisoning SULTAN UL ULOOM COLLEGE OF PHARMACY 4

5. EVOLUTION After the second world war a large number of medicines and Chemicals were introduced into the market. consequent to this globally there was a higher incidence of intentional and unintentional poisoning especially in children. Healthcare professionals had little knowledge about the ingredients present in new products, in view of the increasing incidence of poisoning and lack of awareness among the public about the effects of poisoning the first poison information services were established in Europe in 1940. SULTAN UL ULOOM COLLEGE OF PHARMACY 5

6. Indian scenario In India, As of 2010 there was only 4 WHO recognised centres in India. in addition a few other centres established. the first national poison information Centre was established in December 1994 At ‘All India Institute of Medical Sciences’(AIIMS), New Delhi. The Other centres were subsequently established at national institute of occupational health, Ahmedabad government General Hospital, Chennai and Amrita Institute of Medical Sciences and Research Cochin . SULTAN UL ULOOM COLLEGE OF PHARMACY 6

7. FUNCTIONS….. 1 . Provision of information and advise: The main function of Poison information centre is to provide information and advise concerning the diagnosis, treatment & prevention of poisoning, as well as about the toxicity of chemicals and risks they pose. To provide information on toxic chemicals, including data on risks to the environment and on safe levels in food & environmental media as well as in the work place. All information and advise should be adapted to the specific circumstances of the suspected poisoning i.e. whether exposure to the poison is acute or chronic, and the condition of the patient involved, taking into consideration the type of enquiry and the enquirer’s technical understanding of the poisoning. The information service must be available 24hrs a day, seven days a week, throughout the year. SULTAN UL ULOOM COLLEGE OF PHARMACY 7

8. FUNCTIONS….. 2. Patient management: It is necessary to confirm whether poisoning has actually occurred, to ensure that the proper first-aid measures can be taken, and to assess what type of treatment, if any, is required. The centre exists to provide information, giving advise on the different aspects of diagnosis and treatment that is appropriate to the enquirer’s understanding level. The close association between poison information services & poison treatment services, facilitates the necessary updating and expansion of information on the diagnosis and treatment of local poisoning cases, encourages follow of patients & stimulates essential research on human toxicology and patient management . SULTAN UL ULOOM COLLEGE OF PHARMACY 8

9. FUNCTIONS….. 3. Laboratory services: A laboratory service for toxicological analysis and biomedical investigations is essential for the diagnosis, assessment and treatment of certain types of poisoning. It is especially important for clinical units treating poisoned patients: without analytical data, many toxicological problems can’t be accurately assessed. Laboratory service can also determine the kinetics of the toxin, particularly its absorption, distribution, metabolism & elimination. Analytical facilities are also essential for research and for monitoring populations at risk from exposure to toxic chemicals. A laboratory should have adequate staff & equipment to carry out the analysis that are essential in cases of poisoning with in the country or region. It requires at least one trained analyst & one assistant, but larger numbers of personnel will be needed as the range of techniques in use & the number of analysis being performed increases . SULTAN UL ULOOM COLLEGE OF PHARMACY 9

10. FUNCTIONS….. 4. Teaching & training: The centre with educational responsibilities will train the medical practitioners & other professional health workers likely to encounter the poisoning. 5. Toxicovigilence : It is the active process of identifying and evaluating the toxic risks existing in a community and evaluating the measures taken to reduce or eliminate them. The role of a centre in toxicovigilence is to alert the appropriate health and other authorities so that the necessary preventive and regulatory measures may be taken. SULTAN UL ULOOM COLLEGE OF PHARMACY 10

11. Drug information & Pharmacovigilence Poison information centers are automatically concerned with problems of ADR and side effects. Poison information thus have the responsibility of contributing to Pharmacovigilence in collaboration with other institutions established for that purpose. Drug & poison information centre is one that provides information regarding both drugs & poisons . SULTAN UL ULOOM COLLEGE OF PHARMACY 11

12. Benefits It offers considerable direct health benefits by reducing morbidity & mortality from poisoning Specific antidotes , therapeutic agents and medical equipment can be made more easily available through coordination of stocks. Also help to prevent the unnecessary use of special antidotes and of sophisticated and expensive treatments. Access to information and advise at poison information centers stimulate the interest of local communities and makes them more committed to the prevention of poisoning. Help in promoting the awareness of special requirements concerning the control and regulation of chemicals. SULTAN UL ULOOM COLLEGE OF PHARMACY 12

13. Establishing a PIC A poison information centre should be available in every country irrespective of its size or population. Location: The centre should be located at a leading hospital with emergency & intensive care services as well as the medical library and lab. It should be linked directly with the hospital department where poison patients are treated. The lab facilities of such hospitals should allow toxicological analysis It should operate 24hrs a day all year round. SULTAN UL ULOOM COLLEGE OF PHARMACY 13

14. Staff: PIC needs a multidisciplinary team of poison information specialist lead by physicians with toxicological experience. The team may include physicians, nurses, analysts, pharmacists veterinarians and other scientists from various fields including biology, chemistry, medicine and pharmacology. A poison information specialist helps to prepare & provide information & advise on preventing and dealing with poisoning. A poison information specialist should work under the supervision of medical toxicologist. Minimum of 2 poison information specialists should be on duty to answer calls. SULTAN UL ULOOM COLLEGE OF PHARMACY 14

15. Equipment & facilities: Suitable office furniture & facilities for the storage of confidential data. Specific areas should arranged for answering telephone enquiries, consultation with patients, preparation of documents, staff meetings and secretarial and administrative work. Additional desk space is needed at centers using computer equipment and on-line databases, air conditioning and humidity control may also be necessary. PIC’s should their own libraries & facilities for handling and reproducing documents. A fax machine is necessary which is recognized means of communicating information rapidly among centers and hospitals during emergencies. SULTAN UL ULOOM COLLEGE OF PHARMACY 15

16. ORGANIZATION & OPERATION The effective function of a poison information centre depends on the availability of an adequate volume of evaluated data to furnish a basis for the advise given. PIC’s should establish a mechanism for obtaining access to adequate data on commercial products from manufacturers and should be regularly updated &its confidentiality protected. Once a PIC becomes operational, i.e. able to offer an emergency response service, it should function around the clock. The information handled by PIC relating to manufactured products and patients, must be considered as confidential. Rapid identification of poisons or type of poison involved in an emergency is one of the centre’s main task. SULTAN UL ULOOM COLLEGE OF PHARMACY 16

17. MINIMUM SOURCES REQUIRED FOR A POISON INFORMATION CENTRE Primary resources: human and environmental toxicology published by Macmillan basing stock England , online general scanning services for example A M E D E O current awareness in clinical toxicology , Neurotoxicology published by Raven press New York USA Pharmacology and toxicology published by books gard Copenhagen Denmark toxicology published by Elsevier limerick Ireland toxicology and applied Pharmacology published by academic press San Diego CA USA journal of medical toxicology Indian Journal of environment and toxicology SULTAN UL ULOOM COLLEGE OF PHARMACY 17

18. SYSTEMATIC APPROACH IN HANDLING POISON INFORMATION QUERIES 1. Obtain the requesters demographics 2. collect the background information 3. assess the patient's condition 4. develop and conduct a search strategy 5. evaluate and provide information 6. conduct follow up and documentation 7. maintain confidentiality SULTAN UL ULOOM COLLEGE OF PHARMACY 18

19. Secondary resources POISINDEX WikiTOX http://curiculum.toxicology.wikispaces.net/ Toxbase Intox MEDLINE Toxicology abstracts Toxline Excerpta medica Index medicus SULTAN UL ULOOM COLLEGE OF PHARMACY 19

20. Teritiary resources: SULTAN UL ULOOM COLLEGE OF PHARMACY 20

21. THANK YOU SULTAN UL ULOOM COLLEGE OF PHARMACY 21