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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; Peter.Zed@cdha.nshealth.ca

Abstract

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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

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