Hostname: page-component-cd9895bd7-gvvz8 Total loading time: 0 Render date: 2024-12-23T12:28:32.273Z Has data issue: false hasContentIssue false
  • English
  • Français

Adequacy of antidote stocking in British Columbia hospitals: The 2005 Antidote Stocking Study

Published online by Cambridge University Press:  21 May 2015

Matthew O. Wiens ,
Peter J. Zed ,
Katherine J. Lepik ,
Riyad B. Abu-Laban ,
Jeffrey R. Brubacher ,
Sean K. Gorman ,
Debra A. Kent  and
Roy A. Purssell
Matthew O. Wiens
Affiliation:
Faculty of Pharmaceutical Sciences, University of British Columbia (UBC), Vancouver, BC
Peter J. Zed*
Affiliation:
Emergency Medicine, Pharmacy Department, Queen Elizabeth II Health Sciences Centre, Halifax, NS; College of Pharmacy and Department of Emergency Medicine, Dalhousie University, Halifax, NS
Katherine J. Lepik
Affiliation:
BC Drug & Poison Information Centre (BC DPIC), Faculty of Pharmaceutical Sciences, UBC
Riyad B. Abu-Laban
Affiliation:
Department of Emergency Medicine, VGH; Centre for Clinical Epidemiology and Evaluation, Vancouver Coastal Health Research Institute, Michael Smith Foundation for Health Research, Division of Emergency Medicine, UBC
Jeffrey R. Brubacher
Affiliation:
Department of Emergency Medicine, VGH; BC DPIC; Division of Emergency Medicine, UBC
Sean K. Gorman
Affiliation:
Critical Care, CSU Pharmaceutical Sciences, VGH; Faculty of Pharmaceutical Sciences, UBC
Debra A. Kent
Affiliation:
Poison Control, BC DPIC; Faculty of Pharmaceutical Sciences, UBC
Roy A. Purssell
Affiliation:
Department of Emergency Medicine, VGH; BC DPIC; Division of Emergency Medicine, UBC
*
Queen Elizabeth II Health Sciences Centre, Pharmacy Department – Halifax Infirmary Site, 1796 Summer St., Rm. 2417, Halifax NS B3H 3A7; [email protected]

Abstract

Core share and HTML view are not available for this content. However, as you have access to this content, a full PDF is available via the ‘Save PDF’ action button.
Background:

Inadequate hospital stocking and the unavailability of essential antidotes is a worldwide problem with potentially disastrous repercussions for poisoned patients. Research indicates minimal progress has been made in the resolution of this issue in both urban and rural hospitals. In response to this issue the British Columbia Drug and Poison Information Centre developed provincial antidote stocking guidelines in 2003. We sought to determine the compliance with antidote stocking in BC hospitals and any factors associated with inadequate supply.

Methods:

A 2-part survey, consisting of hospital demographics and antidote stocking information, was distributed in 2005 to all acute care hospital pharmacy directors in BC. The 32 antidotes examined (21 deemed essential) and the definitions of adequacy were based on the 2003 BC guidelines. Availability was reported as number of antidotes stocked per hospital and proportion of hospitals stocking each antidote. For secondary purposes, we assessed factors potentially associated with inadequate stocking.

Results:

Surveys were completed for all 79 (100%) hospitals. A mean of 15.6 ± 4.9 antidotes were adequately stocked per hospital. Over 90% of hospitals had adequate stocks of N-acetylcysteine, activated charcoal, naloxone, calcium salts, flumazenil and vitamin K; 71%–90% had adequate dextrose 50% in water (D50W), ethyl alcohol or fomepizole, polyethylene glycol electrolyte solution, protamine sulfate, and cyanide antidotes; 51%–70% had adequate folic acid, glucagon, methylene blue, atropine, pralidoxime, leucovorin, pyridoxine, and deferoxamine; and <50% had adequate isoproterenol and digoxin immune Fab. Only 7 (8.9%) hospitals sufficiently stocked all 21 essential antidotes. Factors predicting poor stocking included small hospital size (p < 0.0001), isolation (p = 0.01) and rural location (p < 0.0001).

Conclusion:

Although antidote stocking has improved since the implementation of the 2003 guidelines, essential antidotes are absent in many BC hospitals. Future research should focus on determining the reasons for this situation and the effects of corrective interventions.

Keywords

antidoteoverdosetoxicologypoisoning
Type
Original Research • Recherche originale
Information
Canadian Journal of Emergency Medicine , Volume 8 , Issue 6 , November 2006 , pp. 409 - 416
Copyright
Copyright © Canadian Association of Emergency Physicians 2006

References

1.Howland, MA, Weisman, R, Sauter, D, et al. Nonavailability of poison antidotes. N Engl J Med 1986;314:927–8.Google ScholarPubMed
2.Chyka, PA, Conner, HG. Availability of antidotes in rural and urban hospitals in Tennessee. Am J Hosp Pharm 1994;51:1346–8.Google Scholar
3.McGuigan, MA, Yamada, J. The geographical distribution of tuberculosis and pyridoxine supply in Ontario. Can J Hosp Pharm 1995;48:348–51.Google ScholarPubMed
4.Dart, RC, Stark, Y, Fulton, B, et al. Insufficient stocking of poisoning antidotes in hospital pharmacies. JAMA 1996;276:1508–10.Google Scholar
5.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
6.Bailey, B, Bussieres, J. Antidote availability in Quebec hospital pharmacies: impact of N-acetylcysteine and naloxone consumption. Can J Clin Pharmacol 2000;7:198–203.Google ScholarPubMed
7.Gorman, SK, Zed, PJ, Purssell, RA, et al. Antidote stocking in British Columbia hospitals. Can J Emerg Med 2003;5(1):12–7.CrossRefGoogle ScholarPubMed
8.Hruby, K. Availability of antidotes in hospital pharmacies in the Czeck Republic. Ceska Slov Farm 2003;52:231–40.Google Scholar
9.Solheim, L, Andrew, E, Jacobsen, D. Antidote availability in Norway. Tidsskr Nor Laegeforen 2002;122:1111–3.Google Scholar
10.Plataki, M, Anatoliotakis, N, Tzanakis, N, et al. Availability of antidotes in hospital pharmacies in Greece. Vet Hum Toxicol 2001;43:103–5.Google ScholarPubMed
11.Higgins, MA, Evans, R. Antidotes – inappropriate timely availability. Hum Exp Toxicol 2000;19:485–8.CrossRefGoogle ScholarPubMed
12.Jacobsen, Pm. Kristensen, TR, Jensen, K. Availability of antidotes in Denmark. Ugeskr Laeger 2004;166:4257–60.Google Scholar
13.Ong, HC, Yang, CC, Deng, JF. Inadequate stocking of antidotes in Taiwan: is it as serious problem? J Toxicol Clin Toxicol 2000;38:21–8.CrossRefGoogle ScholarPubMed
15.Santucci, KA, Shah, BR, Linakis, JG. Acute isoniazid exposures and antidote availability. Pediatr Emerg Care 1999;15:99–101.Google Scholar
16.Juurlink, DN, McGuigan, MA, Paton, TW, et al. Availability of antidotes at acute care hospitals in Ontario. CMAJ 2001;165:27–30.Google Scholar
17.Maw, G, Aitken, P. Isoniazid overdose: a case series, literature review and survey of antidote availability. Clin Drug Invest 2003;23:479–85.CrossRefGoogle ScholarPubMed
18.Bailey, B, Bussieres, JF, Dumont, M. Availability of antidotes in Quebec hospitals before and after dissemination of guidelines. Am J Health Syst Pharm 2003;60:2345–9.CrossRefGoogle ScholarPubMed
19.Dart, et al. Combined evidence-based literature analysis and consensus guidelines for stocking of emergency antidotes in the United States. Ann Emerg Med 2000;36:126–32.Google Scholar
20.Bussieres, J, Bailey, B. Insufficient stocking of antidotes in hospital pharmacies: problem, causes, and solution. Can J Hosp Pharm 2000;53:325–37.Google Scholar
21.Antidote stocking guidelines for BC hospitals. BC Drug and Poison Information Centre, Vancouver, BC. Feb. 20, 2003; updated Apr. 7, 2005. Available: http//www.dpic.org/DPIC/Home.htmlGoogle Scholar
22.Hospital address list [online]. 2005 Apr 22 [cited Aug 2005]; Available: http://www.hlth.gov.bc.ca/socsec/pdf/hospitallist.pdfGoogle Scholar
23.Population utilization rates and referrals for easy comparative tables (PURRFECT) [electronic database on CD-ROM]. Version 11. Victoria: British Columbia Ministry of Health; 2005.Google Scholar
24.Sivilotti, MLA, Eisen, JS, Jaques, SL, et al. Can emergency departments not afford to carry essential antidotes? Can J Emerg Med 2002;4(1):23–33.Google Scholar