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Antidote stocking in British Columbia hospitals

Published online by Cambridge University Press:  21 May 2015

Sean K. Gorman ,
Peter J. Zed ,
Roy A. Purssell ,
Jeffrey Brubacher  and
Gillian A. Willis
Sean K. Gorman
Affiliation:
CSU Pharmaceutical Sciences, Vancouver General Hospital, Vancouver, BC Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, BC
Peter J. Zed*
Affiliation:
CSU Pharmaceutical Sciences, Vancouver General Hospital, Vancouver, BC Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, BC Division of Emergency Medicine, Department of Surgery, University of British Columbia, Vancouver, BC
Roy A. Purssell
Affiliation:
Division of Emergency Medicine, Department of Surgery, University of British Columbia, Vancouver, BC CSU Emergency Medicine, Vancouver General Hospital, Vancouver, BC British Columbia Drug and Poison Information Centre, Vancouver, BC
Jeffrey Brubacher
Affiliation:
Division of Emergency Medicine, Department of Surgery, University of British Columbia, Vancouver, BC CSU Emergency Medicine, Vancouver General Hospital, Vancouver, BC British Columbia Drug and Poison Information Centre, Vancouver, BC
Gillian A. Willis
Affiliation:
Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, BC British Columbia Drug and Poison Information Centre, Vancouver, BC
*
CSU Pharmaceutical Sciences, Vancouver General Hospital, 855 West 12th Ave., Vancouver BC V5Z 1M9; 604 875-4077, fax 604 875-5267, [email protected]

Abstract

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Introduction:

Previous studies have demonstrated that antidotes are insufficiently stocked in Canadian and US health care facilities. The purpose of this study was to determine the adequacy of antidote stocking in British Columbia hospitals based on the current guidelines.

Methods:

A written survey was mailed to hospital pharmacy directors at all 93 acute care facilities in BC. Availability of 14 essential antidotes was classified as sufficient or insufficient based on the current guidelines. Facilities were stratified into small (<50 beds), medium (50–250 beds) or large (>250 beds); teaching or non-teaching; trauma or non-trauma, urban or rural, and isolated or non-isolated.

Results:

Complete responses were received from 75 (81%) of 93 hospitals. No hospital had adequate stock of all 14 antidotes. Overall, the average number (± standard deviation) of antidotes adequately stocked was 4.2 ± 2.9 per hospital. Urban hospitals had adequate stocks of 6.5 ± 2.6 antidotes while rural centres had adequate stocks of 2.6 ± 1.8 (p < 0.001). Corresponding figures were 9.0 ± 1.8 for teaching hospitals vs. 3.7 ± 2.4 for non-teaching hospitals (p < 0.001), 8.9 ± 2.0 for trauma centres vs. 3.8 ± 2.5 non-trauma centres (p < 0.001), and 2.5 ± 2.1 for isolated hospitals vs. 4.6 ± 2.9 for non-isolated hospitals (p = 0.018). Small, medium, and large hospitals adequately stocked 2.3 ± 1.7, 5.7 ± 2.2, and 7.7 ± 3.0 antidotes, respectively (p < 0.001). The 4 antidotes most adequately stocked were sodium bicarbonate (77%), N-acetylcysteine (64%), ethanol (49%) and naloxone (47%). Digoxin immune Fab fragments, glucagon, pyridoxine and rattlesnake antivenin were poorly stocked with sufficient supplies of 5%, 7%, 7% and 13%, respectively.

Conclusion:

BC hospitals do not have adequate antidote stocks. Provincial stocking guidelines and coordination of antidote purchasing and stocking are necessary to correct these deficiencies.

Keywords

antidoteoverdosetoxicologypoisoning
Type
Toxicology • Toxicologie
Information
Canadian Journal of Emergency Medicine , Volume 5 , Issue 1 , January 2003 , pp. 12 - 17
Copyright
Copyright © Canadian Association of Emergency Physicians 2003

References

1.Selected vital statistics and health status indicators. One hundred and twenty-ninth annual report 2000. Ministry of Health Planning, Division of Vital Statistics, Govt of BC; 2000. Available: www.vs.gov.bc.ca/stats/annual/2000/tab43.html (accessed 2002 Nov 12).Google Scholar
2.Dart, RC, Goldfrank, LR, Chyka, PA, Lotzer, D, Woolf, AD, McNally, J, et al. Combined evidence-based literature analysis and consensus guidelines for stocking of emergency antidotes in the United States. Ann Emerg Med 2000;35:126–32.Google Scholar
3.Dart, RC, Stark, Y, Fulton, B, Koziol-Mclain, J, Lowerstein, SR.Insufficient stocking of poisoning antidotes in hospital pharmacies. JAMA 1996;276:1508–10.CrossRefGoogle ScholarPubMed
4.Woolf, AD, Chrisanthus, K.On-site availability of selected antidotes: results of a survey of Massachusetts hospitals. Am J Emerg Med 1997;15:62–6.CrossRefGoogle ScholarPubMed
5.Howland, MA, Weisman, R, Sauter, D, Goldfrank, L.Nonavailability of poison antidotes [letter]. N Engl J Med 1986;314:927–8.Google Scholar
6.Chyka, PA, Connor, HG.Availability of antidotes in rural and urban hospitals in Tennessee. Am J Hosp Pharm 1994;51:1346–8.Google Scholar
7.Teresi, WM, King, WD.Survey of the stocking of poison antidotes in Alabama hospitals. South Med J 1999;92:1151–6.Google Scholar
8.Juurlink, DN, McGuigan, MA, Paton, TW, Redelmeier, DA.Availability of antidotes in acute care hospitals in Ontario. CMAJ 2001;165:27–30.Google Scholar
9.Bailey, B, Bussieres, JF.Antidote availability in Quebec hospital pharmacies: impact of N-acetylcysteine and naloxone consumption. Can J Clin Pharmacol 2000;7:198–204.Google ScholarPubMed
10.Sivilotti, MLA, Eisen, JS, Lee, JS, Peterson, RG.Can emergency departments not afford to carry essential antidotes? CJEM 2002;4(1):23–33.Google Scholar
11.Burda, AM.Poison antidotes: issues of inadequate stocking with review of uses of 24 common antidotal agents. J Pharm Prac 1997;10:235–48.Google Scholar
12.Daws, D, Willis, GA, Lepik, KJ, Kent, DA, Gorman, S.Coordinated antidote distribution — a poison control center model [abstract]. Can J Hosp Pharm 2002;55 (suppl 3):S29.Google Scholar