National audit of antidote stocking in acute hospitals in the UK

Thanacoody, Ruben; Aldridge, Gloria; Laing, Willie; Dargan, Paul I.; Nash, Stephen; Thompson, John Paul; Vale, Allister; Bateman, Nick; Thomas, Simon

doi:10.1136/emermed-2012-201224

Cited by 37 publications

(48 citation statements)

References 17 publications

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“…There was suboptimal availability within 1 hour, of antidotes for the treatment of poisoning with glycol and alcohol. The authors observed that despite the presence of national guidelines, there was little improvement in antidote stocking and there were no studies exploring the reasons for inadequate stocking in UK [2]. In Canada, the findings were similar following the introduction of guidelines.…”

Section: Discussionsupporting

confidence: 61%

“…The questionnaire enquired on the quantities and availability of 29 antidotes of which 28 had been recommended in the 2008 College of Emergency Medicine/National Poisons Information Service (CEM/NPIS) antidote guidelines. Intralipid was added to the list by the authors of the UK national audit, as it is recommended for patients severely poisoned with local anesthetics and lipid-soluble drugs [2]. The antidotes were categorized as A (having 12 antidotes for immediate availability in the Emergency Department (ED) or any area where poisoned patients are initially treated i.e.…”

Section: Methodsmentioning

confidence: 99%

“…The questionnaire is an adapted version of the one used in the UK national audit, [2] and permission was obtained from the author. The questionnaire enquired on the quantities and availability of 29 antidotes of which 28 had been recommended in the 2008 College of Emergency Medicine/National Poisons Information Service (CEM/NPIS) antidote guidelines.…”

Section: Methodsmentioning

confidence: 99%

“…It is recommended that hospitals should carry out Hazard Vulnerability Assessment (HVA) for proper stocking of antidotes [3]. Despite the publication of guidelines, a national audit of the acute hospitals in UK revealed that there was significant variation in antidote stocking and that some antidotes for treating poisoning with digoxin, cyanide and toxic alcohols were often not stocked [2].…”

Section: Introductionmentioning

confidence: 99%

“…The term 'antidote' is used to refer to any agent used to chelate the toxin, enhance its elimination, neutralize its effect, or ameliorate future complications, rather than just a pure pharmacological antagonist [1]. Antidotes are lifesaving, for example following digoxin or cyanide poisoning and must be available at the appropriate time to be effective.However, it has been reported globally that there is insufficient local availability of essential antidotes, which is of concern as poisoning with certain agents is associated with severe morbidity and mortality [2][3][4][5][6][7][8].…”

Section: Introductionmentioning

confidence: 99%

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The Availability of Antidotes in Public Hospitals in Kuwait: A Cross Sectional Survey

Abahussain¹

2014

J Pharma Care Health Sys

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Objective: Inadequate availability of essential antidotes is reported in many countries. Information on the availability of antidotes in Kuwait is not available. The aim is to determine whether there are adequate stocks of antidotes in public hospitals in Kuwait and to identify the presence of guidelines for antidote stocking and sharing and to determine the presence of emergency medicine pharmacists in the emergency departments. Methods:A cross-sectional study was carried out using a questionnaire distributed to chief pharmacists of six public hospitals in Kuwait. The questionnaire enquired on the availability of 29 antidotes.Results: All the chief pharmacists responded to the survey. The antidotes that were not available in any of the hospitals were botulinum antitoxin, calcium gluconate gel, dicobaltedetate, fomepizole, sodium calcium edetate, sodium thiosulphate, succimer and unithiol. There was substantial variation in the availability of antidotes, especially for cyanide poisoning, ranging from no hospitals for sodium thiosulphate to one hospital each for sodium nitrite and hydroxocobalamin. Only two hospitals had stocks of the polyvalent snake antivenom. Only three hospitals had sharing agreements. Kuwait does not have guidelines for stocking antidotes. None of the hospitals had emergency medicine pharmacists. Conclusion:The six general hospitals in Kuwait have inadequate availability of certain antidotes. Urgent measures, by creating a national guideline for antidote stocking and enforcing antidote hazard vulnerability assessment and establishing a poison control centre, are needed to reduce morbidity and mortality of poisoned patients in Kuwait.

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Section: Discussionsupporting

confidence: 61%

Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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The Availability of Antidotes in Public Hospitals in Kuwait: A Cross Sectional Survey

Abahussain¹

2014

J Pharma Care Health Sys

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Naloxone Administration in US Emergency Departments, 2000–2011

et al. 2015

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Rates of opioid overdose and opioid-related emergency department (ED) visits have increased dramatically. Naloxone is an effective antidote to potentially fatal opioid overdose, but little is known about naloxone administration in ED settings. We examined trends and correlates of naloxone administration in ED visits nationally from 2000 to 2011. Using data from the National Hospital Ambulatory Medical Care Survey, we examined ED visits involving (1) the administration of naloxone or (2) a diagnosis of opioid overdose, abuse, or dependence. We assessed patient characteristics in these visits, including concomitant administration of prescription opioid medications. We used logistic regression to identify correlates of naloxone administration. From 2000 to 2011, naloxone was administered in an estimated 1.7 million adult ED visits nationally; 19 % of these visits recorded a diagnosis of opioid overdose, abuse, or dependence. An estimated 2.9 million adult ED visits were related to opioid overdose, abuse, or dependence; 11 % of these visits involved naloxone administration. In multivariable logistic regression models, patient age, race, and insurance and non-rural facility location were independently associated with naloxone administration. An opioid medication was provided in 14 % of visits involving naloxone administration. Naloxone was administered in a minority of ED visits related to opioid overdose, abuse, or dependence. Among all ED visits involving naloxone administration, prescription opioids were also provided in one in seven visits. Further work should explore the provider decision-making in the management of opioid overdose in ED settings and examine patient outcomes following these visits.

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Medical Toxicology and COVID-19: Our Role in a Pandemic

et al. 2020

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Medical toxicology and infectious disease are not specialties traditionally associated with one another. Pandemics, however, have a way of disrupting convention, and in this era of modern medicine, our specialty has much to offer.When a major medical crisis occurs for which there is no known cure, several phenomena may ensue. The public, fearful and increasingly connected to and influenced by social media, the internet, and television, may experiment with self-medication. Institutional bodies, desperate to advance care, may abandon the conventional mechanisms that ensure medication safety in order to facilitate the rapid approval and dissemination of novel pharmacotherapy. When these developments are considered within the context of our specialty, our role becomes clear. As medical toxicologists we serve as a fund of knowledge for our healthcare colleagues and the public: we provide physicians with information regarding antidotal therapy, drug-drug interactions, and novel therapeutics. We advise the public on an individual and community level through poison control centers and public outreach. As a specialty, we have the knowledge base and the position with respect to our peers and our society to monitor, prevent, and manage the toxicities born of a pandemic.

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National audit of antidote stocking in acute hospitals in the UK

Abstract: Stocking of less commonly used antidotes is inconsistent. This is likely to result in delayed access to treatment and worse patient outcomes.

Cited by 37 publications

References 17 publications

The Availability of Antidotes in Public Hospitals in Kuwait: A Cross Sectional Survey

The Availability of Antidotes in Public Hospitals in Kuwait: A Cross Sectional Survey

Naloxone Administration in US Emergency Departments, 2000–2011

Medical Toxicology and COVID-19: Our Role in a Pandemic

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