Availability of Antidotes in Kuwait: A National Audit.

BACKGROUND: Effective management of poisoning requires adequate stocking of antidotes in hospitals that provide emergency care. Antidote stocking represents a major challenge to hospitals all over the world, including Kuwait. OBJECTIVE: This study aimed to evaluate antidote stocking in public and private hospitals that provide emergency care in Kuwait. METHODS: A cross-sectional study using a self-administered questionnaire was conducted from January to December 2018. The questionnaire was designed to assess immediate and non-immediate availability of 41 antidotes in 6 public and 13 private hospitals in Kuwait that provided emergency care. The questionnaire was provided to the pharmacy departments of these hospitals, which were asked to report the availability of antidotes and the reasons for non-availability. Descriptive statistics were used to report demographical data and independent t-test analysis was used to analyze continuous variables. RESULTS: All of the six public hospitals in Kuwait and eight private hospitals returned the completed questionnaires. Among the 14 hospitals surveyed, none had a complete stock of all essential antidotes. The mean (standard deviation [SD]) availability of immediate antidotes in public hospitals was 79.6% (32.6%) compared to 52.1% (44.4%) in private hospitals. Moreover, the mean (SD) availability of non-immediate antidotes was 64.5% (37.7%) in public hospitals compared to 14.7% (22.8%) in private hospitals. CONCLUSIONS: Public and private hospitals in Kuwait have suboptimal stocks of essential antidotes. There is an urgent need to develop expert consensus guidelines to assist hospitals to reduce costs and improve patient care by adequately stocking essential antidotes.

A system-wide solution to antidote stocking in emergency departments: the Nova Scotia antidote program.

OBJECTIVE: Inadequate stocking of essential antidotes in hospitals is an internationally documented problem. A concrete and sustainable system-wide solution for easy access to antidotes in emergency departments (EDs) was developed and implemented in Nova Scotia, Canada. METHODS: Antidote stocking guidelines and a systemwide antidote management strategy were established. A standardized collection of antidotes housed in highly visible containers in provincial EDs was implemented for timely access. Antidote-specific online administration guidelines were developed. Using the poison centre for surveillance, the antidote program maintained a database of antidote utilization patterns; 11 years of data were available for analysis. RESULTS: 2/2 (100%) tertiary care, 9/9 (100%) regional EDs, and 21/25 (84%) community EDs in Nova Scotia stock antidote kits, for an overall compliance rate of 32/36 (89%). A total of 678 antidotes (excluding N-acetylcysteine) were used for 520 patients. The distribution of antidote use by hospital type was 99/678 (14.6%) at community hospitals, 379/678 (55.9%) at regional hospitals, and 200/678 (29.5%) at tertiary care hospitals. The five most commonly used antidotes were: naloxone 143/678 (21.1%), fomepizole 111/678 (16.4%), glucagon 94/678 (13.9%), calcium 70/678 (10.3%), and sodium bicarbonate 67/678 (9.9%). Of the 520 patients in whom antidotes were used, death occurred in 3% (15/520), major outcomes in 35% (183/520), and moderate outcomes in 39% (205/520). CONCLUSION: The Nova Scotia Antidote Program demonstrates that a solution to inadequate antidote stocking is achievable and requires a system-wide approach with ongoing maintenance and surveillance. The frequency and distribution of antidote usage documented in this program supports the need for enhancement of emergency preparedness. The poison centre and hospital pharmacies are crucial to surveillance and maintenance of this program.

Aminophylline shortage and current recommendations for reversal of vasodilator stress: an ASNC information statement endorsed by SCMR.

Pharmacologic reversal of serious or intolerable side effects (SISE) from vasodilator stress is an important safety and comfort measure for patients experiencing such effects. While typically performed using intravenous aminophylline, recurrent shortages of this agent have led to a greater need to limit its use and consider alternative agents. This information statement provides background and recommendations addressing indications for vasodilator reversal, timing of a reversal agent, incidence of observed SISE with vasodilator stress, clinical and logistical considerations for aminophylline-based reversal, and alternative non-aminophylline based reversal protocols.

[Accidents in patients under anticoagulant therapy in the Department of Cardiology at the Yalgado Ouedraogo Teaching Hospital, Ouagadougou (Burkina Faso)]. / Les accidents du traitement anticoagulant dans le Service de Cardiologie du Centre Hospitalier Universitaire Yalgado Ouedraogo de Ouagadougou (Burkina Faso).

This study aimed to evaluate the profile of patients hospitalized for anticoagulant-induced hemorrhage. We conducted a retrospective, descriptive study within the Department of Cardiology at the Yalgado Ouedraogo Teaching Hospital, in Ouagadougou, over a period of 2 years from 1 January 2007 to 31 December 2008. All hospitalized patients with anticoagulant-induced hemorrhage were included in the study. The average age of patients was 49,31 ± 17,68 years, the sex-ratio was 2,17. Myocardial infarction was the first indication for anticoagulant treatment, with a rate of 21.05%. Anti vitamin K (AVK) was associated with hemorrhage in 63,16% (n=12) of patients versus 36,84% (n=7) of patients treated with low molecular weight heparins (LMWH); 10 patients had major hemorrhage while nine patients had minor hemorrhage. The average duration of Anti vitamin K (AVK) treatment was 16 ± 58 weeks. Hemorrhage in the digestive tract was the most frequent symptom (31,58%) and, in 89,47% of patients, treatment was associated with platelet aggregation. Treatment of hemorrhagic accident was based on definitive cessation of anticoagulant therapy in 73,68% of patients. Four patients (21.05%) died. The inaccessibility to antidotes such as protamine sulphate and PPSD (Prothrombin, Proconvertine, Stuart factor, and anti-haemophilia B factor) constitutes a real obstacle to adequate treatment for complications; a better education of patients receiving these drugs would be the most important preventive measure, because more than 50% of these accidents are preventable.

Antidote Availability in Saudi Arabia Hospitals in the Riyadh Province.

Inadequate antidote stocking is a global problem in hospitals. Insufficient supplies and delays in the administration of antidotes could lead to death and additional potentially negative clinical consequences. Our objective was to determine the availability of antidotes in hospitals listed on the Saudi Ministry of Health website in the Riyadh Province and to evaluate the leading poison in Saudi Arabia. A cross-sectional study was conducted using questionnaires. The questionnaires were distributed to pharmacist directors and emergency room-treating physicians in 17 public hospitals throughout the Riyadh Province. None (0/17) of the pharmacies contained the 24 recommended essential antidotes by the expert consensus guidelines for stocking of antidotes in hospitals. Polyvalent scorpion antivenom, atropine sulphate, calcium gluconate, flumazenil and naloxone hydrochloride were stocked in 94.12% (16/17) of hospitals. 66.67% of patients presented with osmolality, and 55.56% of referral patients with opiates, barbiturates, acetaminophen and salicylate. Our findings have important implications for healthcare institutions and pharmaceutical practices. National practice guidelines are needed to assist pharmacists in selecting appropriate antidotes based on the local pattern of poisoning incidents. Therefore, further study in the Kingdom of Saudi Arabia needs to be completed to fully evaluate the availability of antidotes throughout the country.

Expert Consensus Guidelines for Stocking of Antidotes in Hospitals That Provide Emergency Care.

We provide recommendations for stocking of antidotes used in emergency departments (EDs). An expert panel representing diverse perspectives (clinical pharmacology, medical toxicology, critical care medicine, hematology/oncology, hospital pharmacy, emergency medicine, emergency medical services, pediatric emergency medicine, pediatric critical care medicine, poison centers, hospital administration, and public health) was formed to create recommendations for antidote stocking. Using a standardized summary of the medical literature, the primary reviewer for each antidote proposed guidelines for antidote stocking to the full panel. The panel used a formal iterative process to reach their recommendation for both the quantity of antidote that should be stocked and the acceptable timeframe for its delivery. The panel recommended consideration of 45 antidotes; 44 were recommended for stocking, of which 23 should be immediately available. In most hospitals, this timeframe requires that the antidote be stocked in a location that allows immediate availability. Another 14 antidotes were recommended for availability within 1 hour of the decision to administer, allowing the antidote to be stocked in the hospital pharmacy if the hospital has a mechanism for prompt delivery of antidotes. The panel recommended that each hospital perform a formal antidote hazard vulnerability assessment to determine its specific need for antidote stocking. Antidote administration is an important part of emergency care. These expert recommendations provide a tool for hospitals that offer emergency care to provide appropriate care of poisoned patients.

Availability of antidotes in 70 hospitals in Catalonia, Spain. / Disponibilidad de antídotos en 70 hospitales de Cataluña.

BACKGROUND AND OBJECTIVE: Antidotes may have a relevant role in acute intoxication management and the time until its administration can influence patient survival. PATIENTS AND METHOD: Study conducted by a questionnaire sent in early 2015 to 70 hospitals in Catalonia providing emergency services. Qualitative availability on each antidote was considered adequate when present in at least 80% of hospitals. The quantitative availability was considered adequate when at least 80% of hospitals had the number of units of antidote recommended. RESULTS: Lower complexity hospitals (level A) showed a percentage of adequate qualitative and quantitative availability of 66.7 and 42.9% respectively. In higher complexity hospitals (level B) qualitative and quantitative availability was adequate in 64.5 and 38.7% of the antidotes respectively. Data showed no differences between the different health regions as well as a positive correlation (p<.05) between the number of emergencies attended and the percentage of adequate qualitative availability. CONCLUSIONS: The availability of antidotes in Catalonia hospitals is generally low and shows differences across health regions and depending on level of complexity.

Creation of a virtual antidotes network between pharmacy departments of catalan hospitals.

Objetive: To design a virtual antidote network between hospitals that could help to locate on-line those hospitals that stocked those antidotes with the highest difficulty in terms of availability, and ensured that the medication was loaned in case of necessity. METHODS: The application was developed by four hospital pharmacists and two clinical toxicologists with the support of a Healthcare Informatics Consultant Company. RESULTS: The antidotes network in Catalonia, Spain, was launched in July 2015. It can be accessed through the platform: www.xarxaantidots.org. The application has an open area with overall information about the project and the option to ask toxicological questions of non-urgent nature. The private area is divided into four sections: 1) Antidotes: data of interest about the 15 antidotes included in the network and their recommended stock depending on the complexity of the hospital, 2) Antidote stock management: virtual formulary, 3) Loans: location of antidotes through the on-line map application Google Maps, and virtual loan request, and 4) Documentation: As of June, 2016, 40 public and private hospitals have joined the network, from all four provinces of Catalonia, which have accessed the private area 2 102 times, requested two loans of silibinin, one of hydroxocobalamin, three of antiophidic serum and three of botulism antitoxin. Thirteen toxicological consultations have been received. CONCLUSIONS: The implementation of this network improves the communication between centers that manage poisoned patients, adapts and standardizes the stock of antidotes in hospitals, speeds up loans if necessary, and improves the quality of care for poisoned patients.

Objetivo: Diseñar una red virtual de antídotos entre hospitales que permitiese localizar, de forma online, en qué hospitales están ubicados los antídotos con mayor dificultad de disponibilidad y facilitase el préstamo de la medicación en caso de necesidad.Método: La aplicación fue desarrollada por cuatro farmacéuticos de hospital, dos toxicólogos clínicos y el soporte de una empresa informática.Resultados: La red de antídotos de Cataluña entró en funcionamiento en julio de 2015. Puede accederse a través de la plataforma: www.xarxaantidots.org. La aplicación consta de una zona abierta con información general del proyecto y la posibilidad de realizar consultas toxicológicas de carácter no urgente. La zona privada se divide en cuatro secciones: 1) Antídotos: datos de interés de los 15 antídotos en red y dotación recomendada en función de la complejidad del hospital, 2) Gestión del stock de antídotos: botiquines virtuales, 3) Préstamos: localización de antídotos mediante el servidor de aplicaciones de mapas en la web, Google Maps, y solicitud de préstamo virtual y 4) Documentación: Hasta junio de 2016 son 40 los hospitales públicos y privados de las cuatro provincias de Cataluña adheridos; se han registrado 2.102 accesos a la zona privada, solicitado dos préstamos de silibinina, uno de hidroxocobalamina, tres de suero antiofídico y tres de suero antibotulínico. Se han recibido 13 consultas toxicológicas.Conclusiones: La puesta en marcha de la red mejora la comunicación entre centros que atienden a pacientes intoxicados, adecua y homogeneiza la dotación de antídotos de los hospitales, agiliza los préstamos en caso necesario y aumenta la calidad de la atención a los pacientes intoxicados.

Antidote availability in the municipality of Campinas, São Paulo, Brazil.

CONTEXT AND OBJECTIVE:: The lack of availability of antidotes in emergency services is a worldwide concern. The aim of the present study was to evaluate the availability of antidotes used for treating poisoning in Campinas (SP). DESIGN AND SETTING:: This was a cross-sectional study of emergency services in Campinas, conducted in 2010-2012. METHODS:: The availability, amount in stock, place of storage and access time for 26 antidotal treatments was investigated. In the hospitals, the availability of at least one complete treatment for a 70 kg adult over the first 24 hours of admission was evaluated based on stock and access recommendations contained in two international guidelines. RESULTS:: 14 out of 17 functioning emergency services participated in the study, comprising pre-hospital services such as the public emergency ambulance service (SAMU; n = 1) and public emergency rooms for admissions lasting ≤ 24 hours (UPAs; n = 3), and 10 hospitals with emergency services. Six antidotes (atropine, sodium bicarbonate, diazepam, Phytomenadione, flumazenil and calcium gluconate) were stocked in all the services, followed by 13 units that also stocked activated charcoal, naloxone and diphenhydramine or biperiden. No service stocked all of the recommended antidotes; only the regional Poison Control Center had stocks close to recommended (22/26 antidotal treatments). The 10 hospitals had almost half of the antidotes for starting treatments, but only one quarter of the antidotes was present with stocks sufficient for providing treatment for 24 hours. CONCLUSION:: The stock of antidotes for attending poisoning emergencies in the municipality of Campinas is incomplete and needs to be improved.

Antidote availability in the municipality of Campinas, São Paulo, Brazil / Disponibilidade de antídotos no município de Campinas, São Paulo

ABSTRACT CONTEXT AND OBJECTIVE: The lack of availability of antidotes in emergency services is a worldwide concern. The aim of the present study was to evaluate the availability of antidotes used for treating poisoning in Campinas (SP). DESIGN AND SETTING: This was a cross-sectional study of emergency services in Campinas, conducted in 2010-2012. METHODS: The availability, amount in stock, place of storage and access time for 26 antidotal treatments was investigated. In the hospitals, the availability of at least one complete treatment for a 70 kg adult over the first 24 hours of admission was evaluated based on stock and access recommendations contained in two international guidelines. RESULTS: 14 out of 17 functioning emergency services participated in the study, comprising pre-hospital services such as the public emergency ambulance service (SAMU; n = 1) and public emergency rooms for admissions lasting ≤ 24 hours (UPAs; n = 3), and 10 hospitals with emergency services. Six antidotes (atropine, sodium bicarbonate, diazepam, Phytomenadione, flumazenil and calcium gluconate) were stocked in all the services, followed by 13 units that also stocked activated charcoal, naloxone and diphenhydramine or biperiden. No service stocked all of the recommended antidotes; only the regional Poison Control Center had stocks close to recommended (22/26 antidotal treatments). The 10 hospitals had almost half of the antidotes for starting treatments, but only one quarter of the antidotes was present with stocks sufficient for providing treatment for 24 hours. CONCLUSION: The stock of antidotes for attending poisoning emergencies in the municipality of Campinas is incomplete and needs to be improved.

RESUMO CONTEXTO E OBJETIVO: A carência de disponibilidade de antídotos nas salas de emergência é uma preocupação mundial. O objetivo foi avaliar a disponibilidade de antídotos usados no tratamento de pacientes intoxicados no município de Campinas (SP). TIPO DE ESTUDO E LOCAL: Trata-se de estudo transversal de serviços de emergência de Campinas, realizado de 2010-2012. MÉTODOS: A disponibilidade, quantidade estocada, local de armazenamento e tempo de acesso a 26 tratamentos antidotais foi investigada. Nos hospitais, foi avaliada também a disponibilidade de pelo menos um tratamento complete para um adulto de 70 kg nas primeiras 24 horas da admissão, com base em recomendações de estoques e acesso contidas em duas diretrizes internacionais. RESULTADOS: 14 dentre 17 serviços de emergência em funcionamento participaram do estudo, que incluiu serviços pré-hospitalares, como o Serviço de Atendimento Móvel de Urgência (SAMU, n = 1) e três Unidades de Pronto Atendimento (UPAs, internação limitada até 24 horas), além de 10 hospitais com emergência. Seis antídotos (atropina, bicarbonate de sódio, diazepam, fitomenadiona, flumazenil e gluconate de cálcio) estavam estocados em todos os serviços, seguidos de 13 que também estocavam carvão ativado, naloxona, difenidramina ou biperideno. Nenhum serviço tinha estoque de todos os antídotos recomendados; somente o Centro de Controle de Intoxicações regional tinha estoque próximo ao perfil recomendado (22/26 opções terapêuticas). Os 10 hospitais tinham quase metade dos antídotos necessários para iniciar tratamento, mas somente um quarto dos antídotos estava em estoques suficientes para oferecer tratamento por 24 horas. CONCLUSÃO: O estoque de antídotos para atendimento de emergências toxicológicas no município de Campinas é incompleto e deve ser melhorado.

National study on the adequacy of antidotes stocking in Lebanese hospitals providing emergency care.

BACKGROUND: Antidotes stocking is a critical component of hospital care for poisoned patients in emergency. Antidote stocking represents a major health challenge worldwide and in Lebanon. Systematic data monitoring of antidote stocking in Lebanese hospitals is lacking. The objective of this study is to assess the adequacy of antidotes stocking in Lebanese hospitals according to type and quantity and explore the characteristics associated with their differential availability. METHODS: Data collection to assess antidote availability and its correlate was undertaken through a self-administered questionnaire. The questionnaires were distributed by the unit of surveillance at the Ministry of Public Health to eligible hospitals providing emergency care services. The list of essential antidotes was adapted from the World Health Organization (WHO) list and the British Columbia Drug and Poison Information Centre. RESULTS: Among the 85 Lebanese hospitals surveyed none had in stock all the 35 essential antidotes required. The frequency of stocking by type of antidote varied from a minimum of 1.2 % of the hospitals having a (cyanide kit) to 100 % availability of (atropine and calcium gluconate). Teaching hospitals and those with a large bed-capacity reported a higher number of available antidotes for both immediate and non-immediate use than non-teaching hospitals while controlling for the hospital geographical region and public vs private sector. CONCLUSION: The Lebanese hospitals have a suboptimal stock of essential antidotes supply. It is recommended that the Lebanese Ministry of Public Health monitors closely on the hospital premises the adequacy and availability of essential antidotes stock.

Estimating the Quantitative Demand of NOAC Antidote Doses on Stroke Units.

BACKGROUND: The first specific antidote for non-vitamin K antagonist oral anticoagulants (NOAC) has recently been approved. NOAC antidotes will allow specific treatment for 2 hitherto problematic patient groups: patients with oral anticoagulant therapy (OAT)-associated intracerebral hemorrhage (ICH) and maybe also thrombolysis candidates presenting on oral anticoagulation (OAT). We aimed to estimate the frequency of these events and hence the quantitative demand of antidote doses on a stroke unit. METHODS: We extracted data of patients with acute ischemic stroke and ICH (<24 h after symptom onset) in the years 2012-2015 from a state-wide prospective stroke inpatient registry. We selected 8 stroke units and determined the mode of OAT upon admission in 2012-2013. In 2015, the mode of OAT became a mandatory item of the inpatient registry. From the number of anticoagulated patients and the NOAC share, we estimated the current and future demand for NOAC antidote doses on stroke units. RESULTS: Eighteen percent of ICH patients within 6 h of symptom onset or an unknown symptom onset were on OAT. Given a NOAC share at admission of 40%, about 7% of all ICH patients may qualify for NOAC reversal therapy. Thirteen percent of ischemic stroke patients admitted within 4 h presented on anticoagulation. Given the availability of an appropriate antidote, a NOAC share of 50% could lead to a 6.1% increase in thrombolysis rate. CONCLUSIONS: Stroke units serving populations with a comparable demographic structure should prepare to treat up to 1% of all acute ischemic stroke patients and 7% of all acute ICH patients with NOAC antidotes. These numbers may increase with the mounting prevalence of atrial fibrillation and an increasing use of NOAC.

Availability of antidotes and key emergency drugs in tertiary care hospitals of Punjab and assessment of the knowledge of health care professionals in the management of poisoning cases.

This study was conducted to evaluate the availability of antidotes/key emergency drugs in tertiary care hospitals of the Punjab province, and to assess the knowledge of health care professionals in the stocking and administration of antidotes in the proper management of poisoning cases. Seventeen (n=17) tertiary care hospitals of Punjab Pakistan were selected. Two performas (A and B) were designed for 26 antidotes/key emergency drugs and given to the hospital pharmacists and physicians respectively. It was observed that Activated Charcoal, being the universal antidote was found only in 6 hospitals (41%). Digoxin Immune Fab, Edentate Calcium disodium and Glucagon were not available in emergency department of any hospital and even not included in the formulary of any hospital. About 80% pharmacists were aware of the method of preparation of Activated Charcoal and 85% physicians were familiar with its route of administration. Data showed that tertiary care hospitals of Punjab do not stock antidotes according to national drug policy. Moreover the study strongly suggests the development of health care centers and professional by organizing antidote awareness programs, continuous education and record keeping of poisonous cases and availability of emergency drugs around the clock.

The mastery of antidotes: A survey of antidote knowledge and availability among emergency physicians in registered hospitals in China.

AIM: To describe various types of Chinese hospitals' emergency department (ED) physicians' knowledge of antidotes and the comparative availability of toxicological treatments at these hospitals. METHODS: We emailed a written survey to the ED doctors of 900 hospitals in China. The hospitals' names and addresses were obtained and randomly selected from the 6214 hospitals registered by the Chinese Medical Association. The survey included 23 questions on antidotes to commonly seen poisonings as well as questions on the availability of antidotes and decontamination techniques at each hospital. RESULTS: Six hundred and fifty three hospital emergency directors responded to the survey 72.6% response rate). Overall knowledge of antidotes is not high and varied depending on antidote. Physicians in Eastern China, those working in tertiary-level hospitals and those working in hospitals with higher numbers of beds performed significantly better. On average, only 35.6% of the 23 antidotes were available in all reporting hospitals; 54.1% can get these antidotes from nearby hospitals and 42.0% can get them from a local CDC poison control center. However, only 57.3% can get a requested antidote within two hours. Gastric lavage is the most widely used decontamination procedure, and the availability of extracorporeal decontamination techniques is between 67.2% and 79.6% (depending on type). CONCLUSION: Knowledge of specific antidotes correlated significantly with size, type, and region of hospital in China rather than with individual physician characteristics. Significant antidotes remain unavailable or unavailable within 2 h in about half of all hospitals surveyed, although all major acute decontamination treatments and techniques seem quite prevalent.

Drug shortages: Implications for medical toxicology.

CONTEXT: Drug shortages have significantly increased over the past decade. There are limited data describing how shortages impact medical toxicology of drugs. OBJECTIVE: To characterize drug shortages affecting the management of poisoned patients. MATERIALS AND METHODS: Drug shortage data from January 2001 to December 2013 were obtained from the University of Utah Drug Information Service. Shortage data for agents used to treat poisonings were analyzed. Information on drug type, formulation, reason for shortage, shortage duration, marketing, and whether the drug was available from a single source was collected. The availability of a substitute therapy and whether substitutes were in shortage during the study period were also investigated. RESULTS: Of 1,751 shortages, 141 (8.1%) impacted drugs used to treat poisoned patients, and as of December 2013, 21 (14.9%) remained unresolved. New toxicology shortages increased steadily from the mid-2000s, reaching a high of 26 in 2011. Median shortage duration was 164 days (interquartile range: 76-434). Generic drugs were involved in 85.1% of shortages and 41.1% were single-source products. Parenteral formulations were often involved in shortages (89.4%). The most common medications in shortage were sedative/hypnotics (15.6%). An alternative agent was available for 121 (85.8%) drugs; however, 88 (72.7%) alternatives were also affected by shortages at some point during the study period. When present, the most common reasons reported were manufacturing delays (22.0%) and supply/demand issues (17.0%). Shortage reason was not reported for 48.2% of drugs. DISCUSSION: Toxicology drug shortages are becoming increasingly prevalent, which can result in both suboptimal treatment and medication errors from using less familiar alternatives. CONCLUSION: Drug shortages affected a substantial number of critical agents used in the management of poisoned patients. Shortages were often of long duration and for drugs without alternatives. Providers caring for poisoned patients should be aware of current shortages and implement mitigation strategies to safeguard patient care.

Availability of antidotes, antivenoms, and antitoxins in New Zealand hospital pharmacies.

AIM: To assess the adequacy of the types and quantities of antidotes, antivenoms and antitoxins held by New Zealand hospital pharmacies. METHODS: A list of 61 antidotes, antivenoms, antitoxins and their various forms was developed following literature review and consideration of national pharmaceutical listings. An Internet-accessible survey was then developed, validated and, during the period 28 February to 7 April 2014, sent to 24 hospital pharmacies nationally for completion. Results were assessed and compared with published guidelines for adequate stocking of antidotes in hospitals that provide emergency care. RESULTS: The response rate for the survey was 100%. Wide variation in stock levels were reported with only N- acetylcysteine and octreotide held in adequate quantities by all hospitals to manage a single patient for 24 hours. While archaic compounds were still stocked, newer and more effective pharmaceuticals were not. The national replacement cost for expiring drugs was estimated at $171,024, with smaller, more isolated facilities facing the greatest expense and difficulty in achieving timely resupply. CONCLUSION: Shortcomings in the types and quantities of antidotes, antivenoms and antitoxins held by New Zealand hospital pharmacies were recognised. This situation may be improved through national rationalisation of pharmaceutical storage and supply, and implementation of a national antidote database.