.

1. Book
TITLE :THE MANAGEMENT STRATEGY IN TOXICOLOGY AND POISONING
AUTHORS
1)Luisetto mauro , applied pharmacologist , european specialist lab medicine , public hospital pharmacist manager , independent
researcher ,IMA ACADEMY branch ORGANIZATION AND MANAGEMENT , PC 29121 italy maurolu65@gmail.com +393402479620
2) Ghulam Rasool Mashori, professor of pharmacology , Department of Medical & Health Sciences for Woman, Peoples University of
Medical and Health Sciences for Women, Pakistan
3) Oleg Yurievich Latyshev, President of IMA academy
Keywords: TOXICOLOGY, POISONING, MANAGEMENT STRATEGY , PROBLEM SOLVING, RISK MANAGEMENT ICT, EMERGENCY
DEPARTEMENT , SHARING OF THE INFORMATION , BIOMEDICAL DATABASES, MORTALITY RATE, CLINICAL AND ECONOMIC
OUTCOMES
Chapter 1 ABSTRACT
Related poisoning and toxicology is crucial for the security of patients life a medical team whit all the professionality ne eded , the
right avaibility of med. Lab tests, imaging , antidothes aivalability and other drugs stokes to provide the really best therapy.
The same adequate and rapid sistem of information is relevant ( poisoning centre, public institution, biomedical databeses, university
library and other make the difference:Treatring Poisoing differer a lot from a normal pharmacological therapy because antidothes
ofthen need
Of very dedicated dosage and posology to treat in very rapid way a real danger situation .( since death ) .

2. So is possible to say that is needed : right emergency procedure, right comunication system, right Clinicians ( toxicologist, clinicians,
imaging professionals , medicina laboratorist, clinical pharmacist Logistic pharmacist, epidemiologist , healthcare managers and
others) , right procedure, right Documentation ( poisoning, antidothes ) , right and rapid flux of the relevant information (
availability of rare antidothes in other hospital or in regional or national antidothes stokes.
Also right ICT system, right information about ANTIDOTHES STOKES and time to obtain this in emergency. ( RARE ANTIDOTHES,
UNCONVENTIONAL AMOUNT NEEDED FOR MULTIPLE POISONING, DISASTER and other )
Related toxicologial test is requested to can receive results ( first level or second level) In the righ time to modify the therapy
when possible.
The correct availability of laboratory tests ( toxicologial , biochemistry and other ).
Decontaminant and depurative strategy ( dyalisys, emoperfusion, iperbaric therapy et other )need the same a great and efficacy
management.( clinical , pharmaceuticla and organizative).
In this work it will be used a image methods to better introduce the managerial instruments and tequniques Usefull in industry
but also in administration or health care system and so also in toxicological field.
But also ADEGUATE MANAGEMENT STRATEGY are fundamental to controll the complex process (poisoning ) in very usefull
way.
EFFICAY AND EFFECTIVENES OF THE ENTIRE PROCESS.
PROCESS, TASKS, OBJECTIVES , ENDPOINTS
HIERARCHIC OR NOT HIERARCHIG ORG. , MATRIX
Even if apical managers every day use this management intruments scope of this work is to diffuse to all compenent of toxicologica l
bio- medical team the management basic concepts and theory and tools to obtain better clinical and economic results.
Chapter 2 INTRODUCTION
According editorial CLINICAL PHARMACIST MAIL FOCUS “ the main focus of the clinical pharmacist must be applied in priority way
to the most critical patients in order to achieve the best results available . In this condition even benefit of 1 life achieved in
mortality rate is a real golden endpoint (we can think for example to a pediatric poisoning, or severe infectious disease in pregnancy
or the effect of inefficacy immunosuppressive therapy in transplanted et other) . This can be considered in example as a reduction
in NNT to improve a therapeutic strategy”. (1)
Under the light of this approach is etical and correct to apply managerial teqnuiques and strategy also in field of posioning and
toxicology to adequate manage severe and complex events,like rare poisoning, disaster, Multiple poisoning, terroristik attack, nuclear
events tha need a great organizative competence to Act in an unusual condition.
In order to prevent incidents , to reduce probability of errors , to right perfomr every activity involved in Management of the
poisoned subject many managerial discipline can help in relevant way:
TOTAL QUALITY MANAGEMENT
QUALITY CONTROL MANAGEMENT
RISK AND SAFETY MANAGEMENT
MBO MANAGEMET BY OBJECTIVE
OPERATION MANAGEMENT
PROJECT MANAGEMENT- WBS WORK BREAKDOWN STRUCTURE

3. STRATEGIC MAGEMENT- PLANNING
TIME MANAGEMENT
KNOLEDGE MANAGEMENT
DATA MANAGEMENT, EPIDEMIOLOGY
ICT MANAGEMENT
HTA MANAGEMENT
PROBLEM SOLVING
FACILITY MANAGEMENT
LOGISTIC MANAGEMENT
VELOCITY MANAGEMENT Technology and Speed
HR MANAGEMENT – LEADERSHIP-TEAMWORK- COACHING, Participative Management, Empowerment, and Teams
MBWA MANAGEMENT BY WALKING AROUND
CHANGE MANAGEMENT
SUPPLY CHAIN MANAGEMENT
CLINICAL PHARMACIST MANAGEMENT
DISASTER OR SCENARIO PLANNING STRATEGY, CONTINGENCY PLANNING
and many other discipline .
ALSO some teqnuiques are universally consider relevant in managemet :
GANTT DIAGRAM, ROOT CAUSES ANALISYS, RISK ASSESEMENT, FMEA, STRATEGIC ANALISYS, SWOT ANALISYS, DEMING
CYCLE, CRITICAL PATH ANALISYS, KAIZEN, BRAINSTORMING, PROBLEM SOLVING , LATERAL THINKING, BUDGET IMPACT
ANALISY, BENCHMARKING TEQNIQUE,PNL , TRANSACTIONAL ANALISYS BY HARRIS , TEAM LEADERSHIP, MATRIX
ORGANIZATION, NETWORK ORGANIZATION , TEAM BUILDING , DECISION TREE, RISK REGISTER ,FOCUS GROUP ,
SCENARIO PLANNING, DISASTER PLAN , TO DO LIST, LEARNINF BY ERROR , EMOTIONAL AND SOCIAL INTELLIGENCE
MANAGEMENT BY GOLEMAN , Networking and Boundaryless Relationships and many other .
Attitudes and skills like : POLITICAL STARTEGY TO ESTABLISH USEFULL CONNECTIONS, conceptuals, to analyza the contest,
interpersonale, to communicate with efficecncy ,diagnostic, leadership, techincal expertizae, behavioral , emotional intelligence,
proactivity, no extreme thinking are only few example of right tools to be used in critical conditon like poisoning , disaster , or
terroristic attack.
MISSION, OBJECTIVES, STRENGTHS , WEAKENESS
Theory like : SUN TZU : THE ART OF WAR, TAYLORISM , MAX WEBER THEORY
ELI GOLDRATT, E. DE BONO, BRAINSTORMING , LATERAL THINKING , EISENHOWER MATRIX , GANTTDIAGRAM many many other
INTRUMENTS LIKE :
PROFESSIONAL SOCIAL MEDIA, RESEARCHGATE and other make possible to have a great and rapid sharing of informations
about single researcher, research topics, project and many other related kind of Relationship between different medical team also on
distance.
This , usually integrated in every industrial of other economic or business activity as current way of work, Can produce high
performance also in health care settings and also in toxicological events.

4. So some theory and strategies are cited in this work to provide usefull intrument to be added to the classic Toxicolog ical, clinical,
laboratoristic , epidemiological and other competencies.
The poisoning event need of the best biomedical clinical information , as well as other critical healthcare procedure : the best
healthcare professionals but also a right organization and the right intruments .
And to have a right organization at the level requested managemen instrument must be adequately Perfo rmed by healthcare
organization and professionals ( since from first phases of emergency call , pre hospital setting, to the Emergency Trasport
system, to the rapid comunication of clinical information , to the laboratoristic assay, the antidothes availability to the H24 consultan
service of the poison centre et other ) since to the discharge phases.
A very complex system cover H24 for every day in a year and many organization are currently involved .
The logistic of antidothes and other remedies ( in example iperbaric oxigen therapy ) need great organization to obtain clinical and
economical results and the eccicacy and effectiveness required by actusl healthcare standard ( JACHO ) .
Some relevant antidothes are produced in foreing countries and to be received the order must be sended to different countries (
procedure that require many days to be completed ).
Figure n 1
Many theories was introduced : from Weber bureocracy model , to scientific management ( Taylor) , divisionof labour ( A. SMI TH
), MODERNIZATION THEORY , neoclassic perspective HAWTHORNE ,POLIPHONIC ORGANIZATION, CONTINGENCY PERPECTIVE
and other
Related industrial revolution in first 1900 and to the military strategy a global kind of adminitration was introduced to get the better
perfomance in an high competitive world
Management is definied as the administration of an organization .( every kind of org. )
The Manager’s Resources Human, financial, physical, and informational
Performance Means of evaluating how effectively and efficiently managers use resources to achieve objectives

5. It includes the activities of setting the strategy for an organization and coordinating the efforts of its employees to accomp lish its
objectives through the application of available resources, ( financial, natural, technological, and human resources.)
To manage : comes from to handle ( italian languages maneggiare latin words hand and to act )
First historic theory like SUN TZU ( the art of war ) since from 6 th century BC .
Nicolo’ mcchiavelli ( 1515) THE PRINCE related political strategy of power in itlay .
1776 ADAM SMITH : THE WEALTH OF NATION related division of work.
Henri Fayol (1841–1925)in example considers management to consist of five functions:
planning (forecasting)
organizing
commanding
coordinating
controlling
Management LEVEL : senior , middle and lower managers level
At lowe level more technical and at the top more conceptual role.( piramid structure )
HIGH level managers set the policyof the intere organization and make the more high relevance decision.
Lower level: in example front line managers present more scientific - technical competencies
Basics, basic role, skills, implementation of policies and strategies.
Chain of command , division of labour
Basic roles: MINTZBERG
Interpersonal: roles that involve coordination and interaction with employees
Figurehead, leader
Informational: roles that involve handling, sharing, and analyzing information
Nerve centre, disseminator
Decision: roles that require decision-making Entrepreneur, negotiator, allocator
Management Style
Autocratic
Consultative
Participative
Empowerment
Combinations or Flexible

6. Adaptive or Situational Leadership
Management skills include:
political: used to build a power base and to establish connections
conceptual: used to analyze complex situations
interpersonal: used to communicate, motivate, mentor and delegate
diagnostic: ability to visualize appropriate responses to a situation
leadership: ability to lead and to provide guidance to a specific group
technical: expertise in one's particular functional area.
behavioral: perception towards others.
ELI GOLDRATT : TOC theory of constraints

7. fiigure n. 2
Figure n 3 Root causes analisys
Figure n 4 figure n 5
Figure n 6

8. Project risk management
the Risk Register that includes 4 steps: Identify, Analyze, Plan Response, Monitor and Control.
The United States Department of Defense states; "Cost, Schedule, Performance, and Risk" are the four elements through which
Department of Defense acquisition professionals make trade-offs and track program status.There are also international standards. Risk
management applies proactive identification (see tools) of future problems and understanding of their consequences allowing p redictive
decisions about projects.

9. Figure n 7 FIGURE N. 8
Figure n 9 E. De BONO six hats theory
Figure n 10
Figure n 11

10. Figure n 12 Gantt diagram time management figure n 13 SWOT ANALISYS
Figure n 14
Figure n 15
Figure n 16

11. Figure n 17 figure n. 18
TIME MANAGEMENT
PDCA (plan–do–check–act or plan–do–check–adjust) is an iterative 4-step management method used in business for the control and
continuous improvement of processes and products.It knowed as the Deming circle/cycle/wheel, the Shewhart cycle, the control
circle/cycle, or plan–do–study–act (PDSA).
Figure n 19 PLAN DO CHECK ACT CYCLE
Figure n 20

12. Project management: is the practice of initiating, planning, executing, controlling, and closing the work of a team to achieve specific
goals and meet specific success criteria at the specified time. The primary constraints are scope, time, quality and budget
A 2017 study suggested that the success of any project depends on how well four key aspects are aligned with the contextual
dynamics affecting the project, these are referred to as the four P's:
Plan: The planning and forecasting activities.
Process: The overall approach to all activities and project governance.
People: Including dynamics of how they collaborate and communicate.
Power: Lines of authority, decision-makers, organograms, policies for implementation and the like.
he phased (or staged) approach breaks down and manages the work through a series of distinct steps to be completed, and is
often referred to as "traditional" or "waterfall". Although it can vary, it typically consists of five process areas, four phases plus
control:
Typical development phases of an engineering project
initiation
planning and design
construction
monitoring and controlling
completion or closing
PERT DIAGRAM

13. Figure n 21
Figure n. 22 figure n 23

14. Figure 24 figure 25
Figure n 26

15. Other examples can be :
TAYLOR 1900 SCIENTIFIC MANAGEMENT
BEHAVIORAL MANAGEMENT 1900 U. MUNSTERBERG(INDUSTRIAL PSYCOLOGIST)
GANTTS CHARTS: 1910 FOR PLANNING AND SCHEDULING
MAX WEBER 1900 administrator as bureocrat theory
RONALD FISHER : 1900 STATISTICAL METHODS IN MANAGEMENT SETTINGS
PATRICK BLACKETT : similar to the TAYLOR SCIENTIFIC MANAGEMENT , MATHEMATICAL PRINCIPLE APPLIED IN MILITARY
SETTINGS
PUBLIC and ADMINISTRATIVE MANAGEMENT theory
MASLOW AND MC GREGOR HUMAN RELATION MOVEMENT , HIERARCHY PIRAMIDS OF NEED AND THEORY X - AND Y
QUANTITATIVE MANAGEMENT
THE CONTINGENCY PERSPECTIVE
CONTEMPORARY MANAGEMENT
CRISIS MANAGEMENT 1980
The Ghiselli Study(6 Traits of Manager Success –1) Initiative, 2)self-assurance,3) decisiveness, 4) intelligence, 5) need for
occupational achievement, and 6) supervisory ability
Knowledge, Learning, Quality, and Continuous Improvement: Information is the foundation of knowledge , the foundation of
competitive advantage. employee are the competitive advantage!

16. Knowledge workers
The learning organization
Knowledge Management
Involves everyone in an organization in sharing knowledge and applying it to continuously imp rove products and processes
Change, Creativity, Innovation, and Entrepreneurship
change in order to continually improve.
The speed of change in modern business has increased because of globalization- changes in technology.
Creativity is new ideas for improvements, innovation is implementing those ideas.
Entrepreneurship is generating creative ideas and using them through the innovation.
FROM : Guidelines for poison control
II. Technical guidance - 7. Antidotes and their availability“National distribution of antidotes WHO
https://www.who.int/ipcs/publications/training_poisons/guidelines_poison_control/en/index7.html
“Demographic, geographical, and economic factors sometimes hinder the availability of antidotes. In addition, the high cost that results
from infrequent demand and short shelf-life may prevent their widespread distribution. A central "bank" of antidotes could be an
economic and effective means of ensuring distribution, and this should be organized by health authorities in such a way that any
poison victim may be assured of receiving an antidote within the appropriate period of time .
Economic aspects
When considering the cost of antidotes, governments should take into account the social and medical consequences of failure to treat
poisoned patients in an appropriate manner and the continued economic burden on local or national resources that may ensue.
In general, pharmaceutical companies will manufacture and supply antidotes only if they are encouraged by adequate economic returns
for their investment and by simple registration procedures. To this end, governments should consider recent WHO recommendations1
concerning products for export and facilitate the registration of antidotes already evaluated and registered elsewhere.
If antidotes cannot be supplied by the pharmaceutical industry, other means of ensuring their availability should be considered. These
could include the establishment of government manufacturing facilities, a manufacturing pharmacy laboratory, or a system that allows
the importation of antidotes registered elsewhere.
Other ways of using resources efficiently, such as rationalizing the purchase and distribution of antidotes, should also be c onsidered
by health authorities and should take into account the time within which antidotes need to be available for use in treatment. Local
transport conditions should also be considered. Antidotes needed immediately must be stocked at all hospitals, as well as in health
centres or doctors' surgeries if the nearest hospital is some distance away. It may also be necessary to have certain antidot es
available at places of work for use under medical supervision (e.g. in factories using cyanide). Antidotes needed within 2 hours can
be stocked at certain main hospitals; patients can be taken to these hospitals for treatment or the antidotes can be transported -
within the time limit - to the health facilities at which treatment is provided. Antidotes needed within 6 hours may be stocked at
central regional depots, provided that there are adequate facilities for transporting them within the time limit. For all cat egories of
antidotes, there is the further option of keeping a small amount, sufficient to start treatment, in stock locally, further supplies being
obtained from a central source as required.
Where certain types of poisoning are frequent, or in areas where certain chemicals are heavily used, the appropriate antidotes may
be kept in ambulances, operated by physicians, that are sent out to treat cases of poisoning. Poisoning by natural toxins may be
seasonal and may be specific to certain regions (e.g. snake-bites in rural areas during planting and harvesting seasons).

17. Antivenoms may be sent to rural areas during these seasons to be readily available in case of need. The rapid transport of an tidotes
may be needed in certain cirumstances, and appropriate advance arrangements should be made, e.g. for the use of official cars ,
aircraft, or trains. In certain situations, arrangements for the rapid transport of patients to hospitals with appropriate fa cilities and
antidotes may be necessary. Comprehensive instructions on interim treatment measures should be given to first-aid workers or other
medical or paramedical professionals.
Improving availability
The difficulties experienced in obtaining antidotes for the treatment of poisoned patients vary from country to country. While research
in certain areas by industry, and at the international level, could improve the general availability of antidotes, each count ry will need
to identify its own particular problems and take specific action to solve them. A combination of measures will be required, and
collaboration will be necessary between the various individuals and organizations involved.”.
Chapter 3 MATERIAL AND METHODS
Whit an observational method some relevant ( in our opinion ) are analyzed in order to produce a global Conclusion to submit
to the researcher an useful instrument to be deeply applied in toxicological setting To give to the severe poisoned patient the best
organizative process.
The same this instrument make possible to have a right instrument to manage also very complex situation in example due by
terroristic chemical or bacteriological accatsk or multiple cases of intoxication ( nuclear Incident and other ).
All literature comes from biomedical databases like PUBMED or from other open access journal.
After this review are analized the result of a practical experience in a public hospital setting
( provincial hospital with about 700 beds PC area, with 4 hospital linked ).
This Public hospital is linked with other provincial hospital and REGIONAL CENTRE RER for antidothes .
Hub and spoke system.
Chapter 4 RESULTS from literature :
Janati A et al :
“Purpose Hospital manager decisions can have a significant impact on service effectiveness and hospital success, so using an
evidence-based approach can improve hospital management. The purpose of this paper is to identify evidence-based management
(EBMgt) components and challenges. Consequently, the authors provide an improving evidence-based decision-making framework.
Design/methodology/approach A total of 45 semi-structured interviews were conducted in 2016. The authors also established three
focus group discussions with health service managers. Data analysis followed deductive qualitative analysis guidelines. Findings Four
basic themes emerged from the interviews, including EBMgt evidence sources (including sub -themes: scientific and research evidence,
facts and information, political-social development plans, managers' professional expertise and ethical-moral evidence); predictors
(sub-themes: stakeholder values and expectations, functional behavior, knowledge, key competencies and skill, evidence sources,
evidence levels, uses and benefits and government programs); EBMgt barriers (sub-themes: managers' personal characteristics,
decision-making environment, training and research system and organizational issues); and evidence-based hospital management
processes (sub-themes: asking, acquiring, appraising, aggregating, applying and assessing). Originality/value Findings suggest that
most participants have positive EBMgt attitudes. A full evidence-based hospital manager is a person who uses all evidence sources in
a six-step decision-making process. EBMgt frameworks are a good tool to manage healthcare organizations. The authors found
factors affecting hospital EBMgt and identified six evidence sources that healthcare managers can use in evidence-based decision-
making processes.” (2)

18. Rashid Al-Abri:
“One of the key concerns in Health care management is management of change and health care professionals are obligated both t o
acquire and to maintain the expertise needed to undertake their professional tasks, and all are obligated to undertake only those
tasks that are within their competence.1 Moreover, change occurs continuously around us. We may want to support it, be indiff erent
to it, and be passive or participate in it.
The pace of change has increased dramatically.
Managing change is about handling the complexity of the process. It is about evaluating, planning and implementing operations, tactics
and strategies and making sure that the change is worthwhile and relevant.3 Managing change is a complex, dynamic and
challenging process.4 It is never a choice between technological or people-oriented solutions but a combination of all.”(3)
Matthias Briner et al :
“Clinical risk management (CRM) plays a crucial role in enabling hospitals to identify, contain, and manage risks related to patient
safety. So far, no instruments are available to measure and monitor the level of implementation of CRM. Therefore, our object ive was
to develop an instrument for assessing CRM in hospitals. “(4)
According article : (2016) Pharmaceutical Care and Toxicology, a Synergy in High Risk Situation. J App Pharm
“Poisoning is a rare event often, but in some cases whit critical consequences and so the right diagnosis and therapy is a go lden
endpoint. The toxicology medical equip must be multi-professional. Observing the results of bibliography citied in this works and some
university toxicology programs for pharmacists when observe that the clinical pharmacist presence in stabile way in toxicolog ist medical
team give improving in clinical outcomes. Antidotes are used not often but rarely, and physicians need rapid information also in
medicinal chemistry and toxicology field. The management of the systems must involve clinical and logistic pharmacist. The pa thology,
toxicology, pharmacology and medicinal chemistry competence of clinical pharmacist added to the emergency and ICU physician’s
competences can be the right keywords. The skills requested to the clinical pharmacist in order to works in efficiently way in
toxicological medical team are: proactivity, learn about error, critical thinking, collaborative, approach, management ability, problem
solving risk management (therapy errors management, some example and causes. illegible handwriting), we think that in order t o
have a more and efficacy inclusion of clinical pharmacist in the toxicologist equip also psychological and behaviour specific skill are
useful instruments (Luisetto 2016 ijppr) [17]. New instruments as professional social media can give more opportunity to meet
researcher in healthcare field. Luisetto et al int. journal of economics and management sciences 2016 [18,19], Instrument to rapid
share the information between healthcare professionals and to transfer research activities to practical settings“(5)
And in article : New ICT Technologies to Improve Clinical Outcome in Toxicology and Poisoning. Open Acc J of Toxicol. 2017 Is
reported that:
“We strongly ask to international organization involved in hospital standard accreditations requirement to introduce as relevant
instrument a informatics management system (cabinet informative or other systems) in logistics of antidothes. This will make possible
a correct management and to have available the right antidothes in right time for the safety of the poisoned patients and als o for
professionals. As we have seen in example for EMERGENCY DRUG HOSPITAL SYSTEMS we can have also a reduction in total
costs providing an efficiency system. (Almost 53.000 euro in 5 years in an Italian public hospital) [14] we can think in example to
total cost avoided if introduced in many national hospital. This kind of experience can be usefully translated to antidotes and
toxicology filed in many hospital places. This modify in routine can reduce mortality rate due by due by incorrect antidotes stokes
logistics improving also the clinical outcomes related. In example we can see that in different hospital also the stokes and availability
in some classic antidotes as activated charcoal can be insufficient and related the cyanide antidothes we have see that this is not
correctly available in the different world hospital situation related to the difficulty toof industries or other condition that con tribute to the
variability in the request). Also the logistics of rare antidothes is a crucial process (the expiration time control and ordering
procedure of this molecules can be part of an inefficient systems if not adequately controlled). We can also see that a veloc ity
management ICT strategy can gives improving in the efficacy of process related to logistics and to translate rapidly the relevant
information in poisoning situations. In our conclusion adding the ICT power and the clinical pharmaceutical care competences and

19. knowledge added to the toxicological medial team we can have more clinical results reducing mortality rates an d healthcare
costs.”(6)
Trisolini MG:
“Most health care management training programmes and textbooks focus on only one or two models or conceptual frameworks, but
the increasing complexity of health care organizations and their environments worldwide means that a broader perspective is n eeded.
This paper reviews five management models developed for business organizations and analyses issues related to their application in
health care. Three older, more 'traditional' models are first presented. These include the functional areas model, the tasks model and
the roles model. Each is shown to provide a valuable perspective, but to have limitations if used in isolation. Two newer, more
'innovative' models are next discussed. These include total quality management (TQM) and reengineering. They have shown poten tial
for enabling dramatic improvements in quality and cost, but have also been found to be more difficult to implement. A series of
'lessons learned' are presented to illustrate key success factors for applying them in health care organizations. In sum, eac h of the
five models is shown to provide a useful perspective for health care management. Health care managers should gain experience and
training with a broader set of business management models” (7)
A El Taguri:
“Health services have the functions to define community health problems, to identify unmet needs and survey the resources to meet
them, to establish SMART objectives, and to project administrative actions to accomplish the purpose of proposed action programs.
For maximum efficacy, health systems should rely on newer approaches of management as management-by-objectives, risk-
management, and performance management with full and equal participation from professionals and consumers. The public should be
well informed about their needs and what is expected from them to improve their health. Inefficient use of budget allocated to health
services should be prevented by tools like performance management and clinical governance. Data processed to information and
intelligence is needed to deal with changing disease patterns and to encourage policies that could manage with the complex feedback
system of health. e-health solutions should be instituted to increase effectiveness and improve efficiency and informing human
resources and populations. Suitable legislations should be introduced including those that ensure coordination between different sectors.
Competent workforce should be given the opportunity to receive lifetime appropriate adequate training. External continuous evaluation
using appropriate indicators is vital. Actions should be done both inside and outside the health sector to monitor changes and
overcome constraints.” (8)
Gunther Eysenbach et a :
“A strong majority of the literature shows positive effects of HIT on the effectiveness of medical outcomes, which positively supports
efforts that prepare for stage 3 of meaningful use. This aligns with previous reviews in other time frames.”(9)
John Wright et al :
“Problem: There are wide variations in hospital mortality. Much of this variation remains unexplained and may reflect qua lity of care.
Setting: A large acute hospital in an urban district in the North of England.
Design: Before and after evaluation of a hospital mortality reduction programme.
Strategies for change: Audit of hospital deaths to inform an evidence-based approach to identify processes of care to target for the
hospital strategy. Establishment of a hospital mortality reduction group with senior leadership and support to ensure the a lignment of
the hospital departments to achieve a common goal. Robust measurement and regular feedback of hospital deaths using statistic al

20. process control charts and summaries of death certificates and routine hospital data. Whole system working across a health community
to provide appropriate end of life care. Training and awareness in processes of high quality care such as clinical observation,
medication safety and infection control.
Effects: Hospital standardized mortality ratios fell significantly in the 3 years following the start of the programme from 94.6 (95%
confidence interval 89.4, 99.9) in 2001 to 77.5 (95% CI 73.1, 82.1) in 2005. This translates as 905 fewer hospital deaths tha n
expected during the period 2002-2005.
Lessons learnt: Improving the safety of hospital care and reducing hospital deaths provides a clear and well supported goal from
clinicians, managers and patients. Good leadership, good information, a quality improvement strategy based on good local evid ence
and a community-wide approach may be effective in improving the quality of processes of care sufficiently to reduce hospital
mortality.” (10)
Mike English et al :
“There is increasing focus on the strength of primary health care systems in low and middle -income countries (LMIC). There are
important roles for higher quality district hospital care within these systems. These hospitals are also sources of information of
considerable importance to health systems, but this role, as with the wider roles of district hospitals, has b een neglected.
As we make efforts to develop higher quality health systems in LMIC we highlight the critical importance of district hospitals focusing
here on how data on hospital mortality offers value: i) in understanding disease burden; ii) as part of surveillance and impact
monitoring; iii) as an entry point to exploring system failures; and iv) as a lens to examine variability in health system pe rformance
and possibly as a measure of health system quality in its own right. However, attention needs paying to improving data quality by
addressing reporting gaps and cause of death reporting. Ideally enabling the collection of basic, standardised patient level data might
support at least simple case-mix and case-severity adjustment helping us understand variation. Better mortality data could support
impact evaluation, benchmarking, exploration of links between health system inputs and outcomes and critical scrutiny of geog raphic
variation in quality and outcomes of care. Improved hospital information is a neglected but broadly valuable public good.
Accurate, complete and timely hospital mortality reporting is a key attribute of a functioning health system. It can support countries’
efforts to transition to higher quality health systems in LMIC enabling national and local advocacy, accountability and action.”(11)
Jean-Michel Yeguiayan et al :
“Severe blunt trauma is a leading cause of premature death and handicap. However, the benefit for the patient of pre -hospital
management by emergency physicians remains controversial because it may delay admission to hospital. This study aimed to compare
the impact of medical pre-hospital management performed by SMUR (Service Mobile d'Urgences et de Réanimation) with non -
medical pre-hospital management provided by fire brigades (non-SMUR) on 30-day mortality.
The FIRST (French Intensive care Recorded in Severe Trauma) study is a multicenter cohort study on consecutive patients with
severe blunt trauma requiring admission to university hospital intensive care units within the first 72 hours. Initial clinical status, pre-
hospital life-sustaining treatments and Injury Severity Scores (ISS) were recorded. The main endpoint was 30-day mortality.
Among 2,703 patients, 2,513 received medical pre-hospital management from SMUR, and 190 received basic pre-hospital
management provided by fire brigades. SMUR patients presented a poorer initial clinical status and higher ISS and were admitt ed to
hospital after a longer delay than non-SMUR patients. The crude 30-day mortality rate was comparable for SMUR and non-SMUR
patients (17% and 15% respectively; P = 0.61). After adjustment for initial clinical status and ISS, SMUR care significantly reduced
the risk of 30-day mortality (odds ratio (OR): 0.55, 95% CI: 0.32 to 0.94, P = 0.03). Further adjustments for the delay to
hospital admission only marginally affected these results.

21. This study suggests that SMUR management is associated with a significant reduction in 30-day mortality. The role of careful medical
assessment and intensive pre-hospital life-sustaining treatments needs to be assessed in further studies” (12)
According article PHARMACEUTICAL CARE AND TOXICOLOGY “Poisoning is a rare event often, but in some cases whit critical
consequences and so the right diagnosis and therapy is a golden endpoint. The toxicology medical equip must be multi-professional.
Observing the results of bibliography citied in this works and some university toxicology programs for pharmacists when observe that
the clinical pharmacist presence in stabile way in toxicologist medical team give improving in clinical outcomes.
Antidotes are used not often but rarely, and physicians need rapid information also in medicinal chemistry and toxicology fie ld. The
management of the systems must involve clinical and logistic pharmacist. The pathology, toxicology, pharmacology and medicinal
chemistry competence of clinical pharmacist added to the emergency and ICU physician’s competences can be the right keywords.
The skills requested to the clinical pharmacist in order to works in efficiently way in toxicological medical team are: proactivity, learn
about error, critical thinking, collaborative, approach, management ability, problem solving risk management (therapy errors
management, some example and causes. illegible handwriting), we think that in order to have a more and efficacy inclusion of
clinical pharmacist in the toxicologist equip also psychological and behaviour specific skill are useful instruments .
New instruments as professional social media can give more opportunity to meet researcher in healthcare field. , Instrument to rapid
share the information between healthcare professionals and to transfer research activities to practical settings. (13)
And in article New ICT Technologies to Improve Clinical Outcome in Toxicology and Poisoning. Open Acc J of Toxicol. 2017 “
We strongly ask to international organization involved in
hospital standard accreditations requirement to introduce asrelevant instrument a informatics management system (cabinetinformative or
other systems) in logistics of antidothes. This
will make possible a correct management and to have available the right antidothes in right time for the safety of the poisoned
patients and also for professionals.
As we have seen in example for EMERGENCY DRUGHOSPITAL SYSTEMS we can have also a reduction in total costs providing an
efficiency system. (Almost 53.000 euro in 5 years in
an Italian public hospital) we can think in example to total cost avoided if introduced in many national hospital.
This kind of experience can be usefully translated to antidotes and toxicology filed in many hospital places. This modify in routine
can reduce mortality rate due by due by
incorrect antidotes stokes logistics improving also the clinical outcomes related. In example we can see that in different hospital also
the stokes and availability in some classic antidotes
as activated charcoal can be insufficient and related the cyanide antidothes we have see that this is not correctly available in the
different world hospital situation related to the difficultyof industries or other condition that contribute to the variability in the request).
Also the logistics of rare antidothes is a crucial process (the expiration time control and ordering procedure of this molecules can be
part of an inefficient systems if not adequately
controlled). We can also see that a velocity management ICT strategy can gives improving in the efficacy of process related to
logistics and to translate rapidly the relevant information in
poisoning situations.
In our conclusion adding the ICT power and the clinical pharmaceutical care competences and knowledge added to the toxicological
medial team we can have more clinical results,
reducing mortality rate and healthcare costs “(14)
in article Rethinking the Hospital Pharmacist Service: Centralized Logistics– Ict Systems and Clinical Pharmaceutical Care002 Strategies
as a Management Opportunity for Public and Private Institutions is possible to verify that :

22. “In last year’s healthcare costs are increased constantly in logarithmic way and this conditions need an high efficiently resource
management system more than past. Drugs, medical devices, diagnostics or medical errors are relevant voice in the public and
private hospital current budget and healthcare Institution and government tray every day to control it. (U.S. HEALTH national
expenditure amounted total 3.0 -3billion U.S. D. The total spending on medicine in the USA was about 6 more than 400 us dollars
in 2015).An high performance HEALTHCARE org. Need today: deep innovations, right management of materials (LOGISTICS drugs
and medical devices use), new technologies knowledge, risk management skills and other resource.”(15)
And in article : “Attitudes and Skills in Business Working Settings: A HR Management Tool”
“ This study move from the necessity to cover the need by professionals and public or private organization to
reduce the high costs involved in some inefficient performances level.
Today more than past working settings are very complex (also due by todays company competitiveness needs,
cultural differences of workers, different educational and university course, personal goal setting, personal attitudes
and other relevant aspect).
High costs are involved in not efficiently in human resource management or by not rapid introduction of the new
UR the new staffs. The total cost of human resource can be reduced of about 30% using a correct management
strategic planning in order to obtain a more rapid and efficient introduction in the working places. Rationalize it is a
golden endpoint as well as a real competitive advantages for the same company and organizations and instrument to well-being for
the same professionals. The cost due by inadequate behavior or psychological profile and HR Management is crucial instrument of
company competition.
Observing the new kind of works in example in ICT technology, social networks and other market we can see that the creativity and
workers wellness are successful tools to differentiating Technologies Products by different producers giving improvement of sales
volume. (Old and new economy differs also by the different concept of works:
in new economy we can have less strictly working condition but more results oriented. Less hierarchic control vs. old economy
industry).
The aim of this work is to observe the actual situation of education in field of emotional intelligence field and then to give some
instruments that can be used by professionals in the different working settings in order to have a good and rapid introduction and to
obtain improvement also in global performances. (Instruments for well-being for the same professionals: Stressing working conditions
easy gives also stress in private life.) Today more than past
working activities are under great competition and rapid change (according to the company competitive needs), less defined and with
more fluid roles , the working time in office/or out of office can change a lot, more new technologies available then past, more
functional organizations towards hierarchy roles. All this new condition creates a hard environment (more than past results oriented).
So the organization researches the best professionalism available (with right HR management skills, Hig E.I.
LEVEL, high behavior and psychological resilience ability and other skills useful for today jungle). So there is a great need to
reduce the gap represented by behavior and psychological skills level required by company and the level of the professionals obtained
in their educational life (schools, university, post university course). To be in condition to obtain high performances since first
working experiences. Everyone can see that many professionals start their
professional activity without a minimal level of emotional or social intelligence skills. Training systems and coaching can help but are
needed deep knowledge in human resource management, and practical application.
In the working places today there is the need to have great skills in communications, conflict management, and proactivity, resilience,
learning by errors, perseverance, critical thinking and much other discipline. Psychological attitudes and skills can influence the working
performance level. In example is known that often negative thinking attitude (tunnel thinking) can create in mind preferential ways
easy to be run and this can create problems in the management of their thinking process with low performances level. (Some
mindfulness strategy can help to improve
psychological attitudes and reducing negative stress).

23. The same thinking in the present time (observing too much the past gives trouble thinking while thinking too much the future can
gives anxiety) help the mind can reinforce itself. Creativity can reduce anxious attitudes.
About 70% of works ability and success depends on emotional intelligence versus 30 % technical abilities (Remember Pareto
paradigm 20/80 similar). The emotional intelligence theory shows that the emotional brain can be more rapid in responding to some
stress stimulus then the rational thinking.
For example studies showed that Amygdala physio-pathology is involved in E. I. management and can give in this situation rapid
response without waiting for the cortical brain control. (neo-cortex/reptilian brain) . When in the same time many strong emotions
stimulation arrives too fast to amygdala the neo cortex is not involved . An easy reactive amygdala can results in working difficulties
in relationship in equip.
Low level of social intelligence gives isolation and depression and low working performances. Conflict are natural in all context and so
in working setting. The self-motivation is strongly involved in professional development.
Successful status is related with high emotional, social and political attitudes. But even if the technical competences are subjects of
usual educational and university policy we see a real gap for the emotional social and relational development in student curriculum.
So in this work, we try to give some elements for improving behavior skills to be active and efficient part of a professional team or
to prevent and resolve conflict. In our opinion some theory are to
be post under right light: and for example: De Bono Seven hats and Lateral thinking (problem solving approach), E. Goldratt TOC
Theory of constraints, about psychological limits (a management theory), translational analysis, emotional and social intelligence,
Pareto paradigm, GANTT diagram, Eisenhower matrix, Deming cycle (total quality management), MASLOV hierarchy of need, but
they only the first of many other.”(16)
Jacobsen D ET AL:
“Antidotes may play an important role in the treatment of poisoning. For many physicians and toxicologists an antidote is an antidote.
According to the IPCS definition, an antidote is a therapeutic substance used to counteract the toxic action(s) of a specified
xenobiotic. Given this wide definition, the efficacy of an antidote may vary considerably depending on which toxic action(s) is/are
being counteracted and on the level of counteracting power: An almost 100% efficacy is see n using specific antagonists, such as
naloxone in opiate poisoning or flumazenil in benzodiazepine poisoning, e.g. resulting in complete reversal of opiate toxicit y unless
complications, such as anoxic brain damage, have developed. At the other end of the efficacy scale, we may place chelating agents
for heavy metal poisoning and diazepam for organophosphorus insecticide poisoning. Therefore, in the IPCS/EC evaluation serie s of
antidotes, some chelating agents are considered only to be an adjunct to supportive care which is the cornerstone of treatment.
When teaching clinical toxicology or recommending the use of antidotes in poisoned patients, the expected efficacy level of t he
antidote in question should be stressed. This may be particularly important in severe poisonings when the antidote may only be
considered as an adjunct to supportive care, e.g. deferoxamine in acute iron poisoning. Unless this is stressed, the unexperienced
physician may rely too much on the antidote and may not pay sufficient attention to the supportive care. In this presentation, the
varying efficacy levels of antidotes are discussed as based on the presently ongoing IPCS/EC evaluation programme on antidotes.
“(17)
In publication : Emergency Pharmaceutical Care in ED and ICU:Toxicology, Infectious Disease, Life Saving Drugs Management,
Pharmacoeconomy as Synergic Knowledge Instrument to Reduce Mortality Rate and Healthcare Cost 2019
“If in emergency medicine time is universally considered “TIME IS BRAIN” in stroke management (and the golden hour) the
pharmacist clinical competencies is a fundamental fact for patient safety in the medical team (in example for administration of
antibiotics in sepsis , thrombolythic therapy, antidotes administration and other) . The clinical pharmacist competencies related intensive
care drugs, pharmacology, toxicology, medicinal chemistry, medical devices, infectious disease, cardiovascular, renal, epatic, neurology
Bone marrow, pulmonary functions and many other in example TDM therapeutic drug monitoring Medicine lab competencies,
Pharmacoeconomy are currently present in curricula studio rum of many clinical pharmacy International course. So Is clear that the
clinical pharmacist and pharmaceutical care skills can be the right instrument to reduce mortality rate and cost containment. The
same the economic results of this approach is a clear undeniable fact. The Clinical Pharmacist Interest is mainly on Some Drugs

24. Classes Management in EM or ICU:
Like
a) Antidotes (A and B priority)
b) Hemo-derivates
c) Some parenteral antimicrobials
d) Anahestetics, Miorelaxants, analgesics and narcotics
e) Cardioactive
f) Electrolites
g) Antipertensive , diuretics
h) Antiepileptics
And Other necessary Emergency drugs to cover the various
emergency need (compoundings, magistral formula) and few other
classes.”(18)
and in a ICU setting “Observing the results of the bio medical literature reported in this work we can say
that the clinical pharmacist presence in stabile way in ICU medical team gives improving in some clinical patient’s outcomes and
reducing mortality rate. This conclusion is related to the complexity of ICU SETTINGS and by critical patient’s condition. To
adequately managed this situations are needed the most complete medical equips (multidisciplinariety). We observe that the role
played by hospital pharmacists can be in more clinical activities, as educator (towards all healthcare professionals),
researcher, and manager functions.”(19)
from editorial velocity management strategy 2016 :“ Mourier P (2001) :The basis for this new style of management is decision‐
making at lightning speed. Velocity management is decision making at speeds consistent with today’s competitive environment and
technology”. This revolutionary instrument make possible to increase in relevant way the communication between Managers and
professionals involved in development of the business. (20)
from article Steps and Impacts of Pharmaceutical Care and Clinical Pharmacy Development on Clinical Outcomes 2016:
A Historical Analysis Compared with Results :
“In order to have a better rational therapy (multi-professional team), such general positive effects obtained in some clinical outcomes
using a pharmaceutical care management approach in medical team has become one of the most prominent objectives of today’s
healthcare authoritiesSuch effects, achieved by clinical pharmacists in the last decades, direct us to a helpful and promising path for
future results in the betterment of healthcare system.
The pharmacists are considered universally as top DRUG specialists and when it comes to many aspects of drug use related to:
pharmaceutical chemistry, pharmacokinetics, toxicology, laboratory assay, imaging, clinical data, EBM and other discipline.
Sharing the scientific knowledge in medical team and adding clinical pharmacy expertise now-a-day is essential to give much better
results in various clinical outcomes.” (22)
ACCORDING article Management Instrument in Pharmaceutical Care and Clinical Pharmacy in 2016 “Clinical pharmacists
professional need to have management instruments to be added totheir classic university core curriculum (Knowledge and practice

25. applications). A rational use of clinical pharmacist’s human resource is a golden endpoint in every setting with the change from
logistic to more clinical function (clinical pharmaceutical care new healthcare discipline.”(23)
Raúl Muñoz, ET AL :
“Toxicovigilance 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.
Through a validated toxicovigilance program (SAT-HULP) we examined the characteristics of acute poisoning cases (APC) attended
in the Emergency Department (ED) of La Paz Hospital (Madrid, Spain) and assessed their economic impact on the health system.
The active poisoning surveillance system performs a daily search for cases in the hospital´s computerized case records. Found cases
are entered into a database for recording of type of poisoning episode, reasons for exposure, causative agent, signs and symptoms
and treatment. We carried out a cross-sectional epidemiological study with analytical projection, based on an impact study on cost
per survivor. The data for the costs attributable to cases of APC observed at HULP (outpatients and inpatients) was obtained from
the based on the information provided by the diagnosis-related groups (DRG) through the corresponding hospital discharge reports
(available through SAT-HULP).
During the first 30 month of SAT-HULP operation we found a total of 3,195 APC, a cumulative incidence rate of 1.75% of patients
attended in the ED. The mean (SD) patient age was 40.9 (17.8) years and 51.2% were men. Drug abuse accounted for 47.5%
of the cases. Suicide attempt was the second most frequent category (38.1%) and other causes accounted for 14.5% of APC. The
total cost of hospital care for our hospital rose to €1,825,263.24 (approximately €730,105.30/year) resulting in a permanent
occupation of 4 beds/year.
SAT-HULP constitutes a validated toxicovigilance tool, which continuously integrates available data in real-time and helps health
services manage APC data flexibly, including the consumption of resources from the health system. “(24)
Steven C. Curry et al :
“There are no published studies that have compared quality outcomes of hospitalized poisoned patients primarily under the care of
physician medical toxicologists to patients treated by non-toxicologists. We hypothesized that inpatients primarily cared for by medical
toxicologists would exhibit shorter lengths of stay (LOS), lower costs, and decreased mortality. Patients discharged in 2010 and 2011
from seven hospitals within the same health care system and greater metropolitan area with Medicare severity diagnosis-related groups
for “poisoning and toxic effects of drugs” with and without major comorbidities or complications (917 & 918, respectively) we re
identified from a Premier® database. The database contained severity-weighted comparisons between expected and observed outcomes
for each patient. Outcome parameters were differences between expected and observed LOS, cost, and percent mortality. These were
then compared among groups of patients primarily admitted and cared for by (1) medical toxicologists at one hospital (Banner Good
Samaritan Medical Center, BGS), (2) non-toxicologists at BGS, and (3) non-toxicologists at six other hospitals. Records of 3,581
patients contained complete data for assessment of at least one outcome measure. Patients cared for by medical toxicologists
experienced favorable differences in LOS, costs, and mortality compared with other patient groups (p < 0.001). If patients cared for
by non-toxicologists had experienced similar differences in observed over expected values for LOS, cost, a nd mortality as those cared
for by medical toxicologists, there would have been a median savings of 1,483 hospital days, $4.269 million, and a significan t
decrease in mortality during the 2-year study period. Differences between observed and expected LOS, cost, and mortality in patients
primarily cared for by medical toxicologists were significantly better than in patients cared for by non -toxicologists, regardless of
facility. These data suggest that significant reductions in patient hospital days, costs, and mortality are possible when medical
toxicologists directly care for hospitalized patients. (25)

26. Whyte IM et al :
“To describe the development and activity of a multidisciplinary service to manage self-poisoning.
Descriptive, comparative study with prospective data collection.
Regional toxicology treatment centre in the Hunter area of New South Wales (NSW) with primary and secondary referral service to
385,000 people and tertiary referral service to a further 100,000.
All patients (1987-1995) with poisoning or envenomation presenting to the Hunter Area Toxicology Service (HATS).
Average length of stay for HATS compared with national and NSW hospitals; mortality data for HATS compared with NSW.
Average length of stay for HATS was 0.53-1.22 days shorter than for all Australian hospitals, potentially saving 518 bed-days,
valued at $468,000 per year. Average length of stay was 0.94-3.39 days shorter than for all NSW hospitals, saving 1470 bed-
days at $1.4 million per year. Inpatient mortality (0.2%; 95% confidence interval, 0.0-1.1) was not significantly different from NSW
(0.5%; 95% CI, 0.2-0.8). Standardised mortality ratios showed no greater all-cause suicide mortality.
In our centralised model for managing self-poisoning, all toxicology patients in an area health service are diverted to one hospital,
where all patients with deliberate self-poisoning are admitted under the one multidisciplinary team, and all receive psychiatric
assessment. This model has substantially reduced bed stay, with considerable savings to the Hunter Area Health Service manifested
as an increase in beds available for other purposes. “(26)
F F S Daly et al :
“Early assessment and management of poisoning constitutes a core emergency medicine competency. Medical and psychiatric
emergencies coexist; the acute poisoning is a dynamic medical illness that represents an acute exacerbation of a chronic underly ing
psychosocial disorder. The emergency physician must use an approach that ensures early decisions address potentially time critical
interventions, while allowing management to be tailored to the individual patient's needs in that particular medical setting. This article
outlines a rationale approach to the management of the poisoned patient that emphasises the importance of early risk assessment.
Ideally, this approach should be used in the setting of a health system designed to optimise the medical and psychosocial care of
the poisoned patient. “(27)
chapter 5 Results of a PRACTICAL EXPERIENCE :
Location PC area 29121
Setting public provincial hospital
Time of observation : 2008-2018
Position observed : hospital pharmacist manager ( applied pharmacologist ) involved in antidothes management provincial stokes.
HOSPITAL PHARMACIST MANAGER WHIT TQM TOTAL QUALITY MANAGEMENT COURSE .( UNIONE INDUSTRIALI TO 1996
).
Way of execution : under a pharmaceutical and managerial approach
Results: during this periods of time no event related to lack of availability in antidothes stokes that causes relevant or letal patient
damages.( no notification from official hospital office ) .
Only few times needed to get some antidothes molecules ( from other hospital or POISON CENTRE or from REGIONAL HUB for
antidothes to treat patients but with out any clinical complications .)
Every year was respected budget related antidothes .
Every level of healthcare managers ( high ,but also lower )mus use manager intruments to adeguately perform high risk job.

27. (This results was obtained WITH the CRR REGIONAL ANTIDOTHES CENTRE and CAV PV collaboration ).
The antidothes hospital stokes in PC area are present in EMERGENCY DEPARTEMENT, ICU, pharmacy And Blood bank .
Great collaboration between medical equip of emergency department , ICU , hospital pharmacy
REGIONAL HUB , poison centre contacted.
Chapter 6 DISCUSSION
Many managerial theory or tools are efficacy applied in many settings with high results as
Outcomes .
Related this real efficacy documented is crucial to transfer this methods also I health care setting and
Also in toxicological medical team ( poisoning and other ) to get the best clinical and economical results
And for the safe of patient life involved.
Many serious condition like severe poisoning, rare poisoning , multiple cases , disaster, terroristic attack , nuclear incident and other
need complex and rapid response and the oganization added to the healthcare professionals make the difference.”
Related the result presented of a practical experice is possible to say that a strictly observance of antidothes normative rules added
to a specific managerial competence of hospital pharmacist make possible an adequate performance towards patients safety in a very
dangerous setting like toxicology and poisoning.
Hospital pharmacist managers whith high competencies also in TQM make possible to be
Facilitator between toxicology medical team, HUB regional antidothes centre CRR RER, central medical office, NATIONAL STOCKPILE
OF ANTIDOTES , ministerial of health office ,polices forces , inside ministry office pharmaceutical industries, import company of
drugs and all other member involved in this kind of process.
Chapter 7 CONCLUSION
Related the result of this bibliographic research ,the practical experience presented and all the current Managerial instruments and
theories is undeniable that this last tools must be deeply introduced and applied in toxicological setting to obtain the best possible
clinical results in cases of severe or complex poisoning.
The right flux of relevant information about poisoned patients or related antidothes characteristic provided by poison center ma ke
possible to achieve the best clinical result possible.
The result presented in this work was obtained using : ICT instruments, managerial strategy, clinical pharmacist competencies, HR
management , risk management and other techniques we have see. Under the light of this practical experience and literature presents
is crucial to ask to International org. involved in hospital accreditation and other public institution ( MINISTRY OF HEALT,
UNIVERSITIES AND OTHER )to deeply introduce managerial concepts and skills in all component of medical team involved in severe
poisoning to achieve the best result available.
IN ORDER TO SETTING THE BEST STRATEGY IN POISONING AND TOXICOLOGY FIELD IS STRONGLY REQUESTED DEEPLY
KNOWLEDGE AND TRAINING RELATED THE TOXIC MOVENS AND RELATED TO THE ANTIDOTHES AND SUPPORTIVE OR
DEPURATIVE STRATEGY OR LABORATORISTIC COMPETENCIES BUT ALSO HIGH HEALTHCARE PROFESSIONALS
MANAGERIAL TRAINING : THE GOOD MANAGEMENT PRACTICE must be introduced in every setting related poisoning and
toxicological event.
If “time is life” in some medical emergencies the same is possible to consider that and adeguate management of all component of
toxicological team from the access to ED to the discharge of a poisoned patient is a fundamental basis to the best therapeutic
strategy .
Chapter 8 Some Guidelines , normatives, websites :

28. IPCS: International Programme on Chemical Safety-Antidotes
The use of essential drugs. Model List of Essential Drugs (ninth list). Seventh report of the WHO Expert Committee. Geneva; World
Health Organization, 1997 (WHO Technical Report Series, No. 867
CAV PAVIA MAUGERI antidothes clinical use guideline 2018-2019
RACC. MINISTERO DELLA SALUTE (ITALY ) N . 7 RACCOMANDAZIONE PER LA PREVENZIONE DELLAMORTE, COMA O
GRAVE DANNO DERIVATI DA ERRORI IN TERAPIA FARMACOLOGICA
THE EMERGENCY DRUG CABINET SYSTEM: L’ARMADIO DELLE URGENZE GESTITO DAL FARMACISTA OSPEDALIERO
CONGRESSO SIFO 2016
OFFICIAL PHARMACOPEIA ITALY , EUROPEAN , US
CRR centro regionale antidoti FERRARA REGIONE EMILIA ROMAGNA https://antidoti.ospfe.it/
Cav CENTRO ANTIVELENI E CENTRO NAZIONALE DI INFORMAZIONE TOSSICOLOGICA DI PAVIA http://www-
3.unipv.it/reumatologia-tossicologia/cav/
Allegato III GAZETTE UFF. EUROPEAN
MANAGEMENT WEBSITE https://www.12manage.com/
Pmbok PROJECT MANAGEMENT last version A Guide to the Project Management Body of Knowledge (PMBOK Guide) from the
Project Management Institute (PMI)
The ISO standards ISO 9000, a family of standards for quality management systems, and the ISO 10006:2003, for Quality
management systems and guidelines for quality management in projects.
ISO 21500:2012 – Guidance on project management. This is the first International Standard related to project management published
by ISO. Other standards in the 21500 family include 21503:2017 Guidance on programme management; 21504:2015 Guidance on
portfolio management; 21505:2017 Guidance on governance; 21506:2018 Vocabulary; 21508:2018 Earned value management in
project and programme management; and 21511:2018 Work breakdown structures for project and programme management.
ISO 31000:2009 – Risk management.
ISO/IEC/IEEE 16326:2009 – Systems and Software Engineering—Life Cycle Processes—Project Management
International Project Management Association Individual Competence Baseline
JACHO in force guideline fo accreditation of healthcare org.
In force activation procedure of national and regional stockpile of antidothes
Decreto del Presidente del Consiglio dei Ministri, 12 gennaio 2017) Articolo 46 - Centri antiveleni. “ Il Servizio sanitario nazionale
garantisce attraverso i Centri Antiveleni (CAV) attività di consulenza specialistica per problematiche di carattere tossicologico di alta
complessità, a supporto delle unità operative di pronto soccorso e degli altri servizi ospedalieri e territoriali, nonchè ade guati sistemi di
sorveglianza, vigilanza e allerta”.
Arizona university program : in collaboration with AACT (American Academy of Clinical Toxicology),that since 1999 is involved of
formative programs towards health care professionals , "Advanced Hazmat Life Support(c) (AHLS) for Toxic Terrorism: Chemical,
Biological, Radiological and Nuclear Incidents," is an offshoot of the AEMRC's two-day AHLS Provider Course that instructs medical
personnel how to care for patients exposed to hazardous materials (hazmat) and chemical, biological, radiological and nuclear
incidents.
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