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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, zed@interchange.ubc.ca

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

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