Development of a paediatric poisons information service in Chennai, India

Year established 2018
Sectors NHS
Country India

Overall goals

To improve timely access to agreed protocols for management of paediatric poisoning in Chennai, and then spreading it to the State of Tamil Nadu.
To support learning of Quality Improvement methodology in Indian Paediatrics.

Key UK Colleagues and Partners

The National Poisons Information Service (NPIS) in Edinburgh has made TOXBASE, the viewdata database, available for free to the clinicians in Chennai.

Sustainable development goals

  • SDG 3 - Good health and well-being

Funding source

None

Project origin

I wanted to take back to India the ideas of clinical governance that I have experienced in the UK, and thought toxicology would be a good area to start with because the NPIS is considered a centre of International excellence, processes may be relatively easy to transfer, and clinical toxicology has very little standardisation in India. I found an advertisement for a planned telephone advice service for paediatric poisoning in Chennai and met the wonderful Dr Thanagavelu, with whom I have been discussing ideas for some time. I had given a few talks at their hospital (Mehta Hospital), as well as in other places in the state of Tamil Nadu. The current project came about because Dr Thangavelu contacted me to help him set up a better paediatric poisons information service, for which there is now moral support from the Indian Association of Paediatrics.

Evidence of need

I visited private and state hospitals that manage paediatric and adult poisoning, and found poor standardisation, and staff who expressed a need for better information. This was also echoed by specialists, who were concerned about the impact of poor care in less resourced hospitals, as well as the challenges of ensuring reliable high quality care 24/7 even in their own centres.

Project areas

Service Improvements

Project activities

We have agreed to set up the Paediatric Poisons Centre – Chennai (currently this is just informal) as a not for profit group
Two senior consultants are testing Toxbase for their cases of poisoning, with a view to making it the resource for use by other staff in due course.
We have obtained agreement from an IT firm (Hexaware) that they will develop for free any IT platform that may be needed for this project.

Changes

Build a local learning network of poisons management specialists who can create and improve protocols based upon experience of use.
Facilitate access to standardised information at the point of use across urban and rural settings, including resource-poor areas.
Ultimately, to improve outcomes for children with poisoning.

Next steps

The two consultants will test the allocation of registrars in two centres (a major challenge) to cover the advice line for the Poisons Centre, to prove that cross-organisational cover is feasible and acceptable.
We are currently setting up a formal survey of the needs and expectations of doctors dealing with paediatric poisoning in Chennai.

Challenges

Getting organisations in India to accept advice from people in other organisations is seemingly difficult, and is a barrier to collaboration. Cheaper short term solutions seem to be preferred by many, but many such attempts have been unsustainable. Poisons management affects predominantly poorer people, and their voices are weaker in demands for services. Practices in poisons management are very different in India compared to the UK, so there is some suspicion of the use of UK protocols in India.

Mitigating challenges

It would be ideal if the development of the service is led predominantly by clinicians in Chennai. They have asked me to tell them what to do, and I have struggled to put it back to them!

Over time, we have tested easier solutions first and seen them fail again, which is the reason why we have now agreed to the set up of the two-centre service.

Testing Toxbase protocols will help us understand and tailor the solutions to the Indian context, and we intend to survey people using a Toxbase example to gauge their interest and build confidence.

Discussions within the Indian Association of Paediatrics are ongoing, and their help might create the right environment for cross-organisational support.

It may be possible to seek support within the Tamil Nadu government, but that might be better left until we are clearer about what we will do.

Partnership principles

  • respectful
  • flexible

Project gains

  • leadership
  • teamwork
  • resilience
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