Background: Organophosphorous poisoning is one of the most common pesticide poisoning in India. Aim of this study is to develop standard treatment protocol to manage cases with a special reference of treatment practice from our tertiary care hospital and various literature resources. Methods: It was descriptive, observational, study conducted at rural tertiary care teaching hospital, within a time period of 6 months. Data were collected retrospectively and prospectively and were documented according to epidemiology, clinical characteristics and Treatment practices of different class of OP poisonings to develop standard treatment protocol for the future reference. Data were analysed using Microsoft excel. Results: Total of 150 patients; 100 retrospective and 50 are prospective. We found that males are more commonly poisoned. Majority of them were within age group of 20-30 years, farmer (62.66%), literate (62.66%), both alcoholic and smokers (52.33%). We also identified 28 different compounds where 11 such compounds were responsible for death (7.33%). It was already documented that there is no evidence of using pralidoxime to the compounds likes Dioxanthion, Phoxim, Propenofos and Prothiophos. There is an evidence of using Vitamin E and Magnesium sulphate for specific OP compounds. We formulated comprehensive guideline for each type of OP compound poisoning for our hospital for better patient care. Conclusion: Early identification of poison through clinical history, appropriate use of antidotes and decontamination procedure has to be reviewed in our hospital. Our guideline gives the insight to evidence based practice for management of OP poisoning.