Antidote stocking in British Columbia hospitals

Abstract

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 F ab 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. RÉSUMÉIntroduction : Des études antérieures ont démontré une réserve insuffisante d'antidotes dans les services de santé canadiens et américains. La présente étude avait comme objectif de déterminer si, en se basant sur les directives existantes, les réserves d'antidotes dans les hôpitaux de la Colombie-Britannique sont suffisantes.

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

“…[1][2][3][4][5][6][7] In most cases of drug overdose, gastric decontamination and supportive care are adequate; however, in some patients the timely administration of an appropriate antidote can be a life-saving intervention. Since this problem was identified in the mid-1980s, 1 subsequent research indicates minimal progress has been made in both urban and rural hospitals.…”

“…Since this problem was identified in the mid-1980s, 1 subsequent research indicates minimal progress has been made in both urban and rural hospitals. [2][3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18] In 2000, the first US consensus guidelines were published, providing direction for hospitals regarding which antidotes were necessary to stock and the quantity recommended. 19 Shortly thereafter, investigators in British Columbia, Quebec and Ontario evaluated the adequacy of antidote stocking in Canadian hospitals.…”

“…19 Shortly thereafter, investigators in British Columbia, Quebec and Ontario evaluated the adequacy of antidote stocking in Canadian hospitals. 7,16,18 Although they applied different criteria, all 3 studies reported gross inadequacies in antidote stocking. In BC, no hospital adequately stocked all 14 evaluated antidotes and 59% adequately stocked fewer than 5 antidotes.…”

Antídotos e medicamentos utilizados para tratar intoxicações no Brasil: necessidades, disponibilidade e oportunidades

“…Antídotos de alto custo, que, em geral, são poucos (p.ex. : anticorpo antidigoxina, desferroxamina, fomepizol, hidroxicobalamina e glucagon), poderiam ser trocados junto aos produtores quando próximos do prazo de vencimento, seguindo a sistemática de compras consignadas, como já é realizado no Canadá, ou disponibilizados para outros serviços regionais de maior demanda 9,17 .…”

“…A despeito da importância dos antídotos e medicamentos usados em intoxicações, diagnós-ticos anteriores apontam para falhas no abastecimento desses em diferentes contextos 4,5,6,7,8,9 . Vários fatores estão associados a esse cenário, incluindo o custo e a necessidade de manutenção de estoques mínimos, que frequentemente vêm a perder validade e precisam ser repostos 8 .…”