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Many hospitals still lacking adequate antidote stocks

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Less than a quarter of hospitals stock all of the recommended antidotes for immediate use in accident and emergency departments, an audit has suggested.

National guidelines for the treatment of poisoned patients were revised in 2013 by the Royal College of Emergency Medicine and National Poisons Information Service.

They were updated following an audit in 2010 that found significant variable stocking and timing of antidotes.

“There remains significant variability particularly for category C antidotes”

Study authors

To assess if the availability and stock levels of antidotes had improved since the revised guidelines, researchers surveyed chief pharmacists from 169 acute hospitals in England, Wales and Northern Ireland.

Questions were asked about antidote availability within the recommended time, and whether recommended stock levels were held, and time to availability if not stocked.

Researchers found availability of category A and B antidotes had improved since the 2010-11 audit and 2013 guidelines.

However, there remained “significant variability” particularly for category C antidotes, they said, noting that “more work” was required to ensure those treating poisoned patients had “timely access” to antidotes, particularly those in category C.

The number of hospitals stocking antidotes within the recommended time increased for 20 of the 22 category A and B antidotes.

But less than a quarter stocked every category A antidote – required for immediate use in A&E for treating poisoning with drugs – such as paracetamol, opioids, and chemicals such as cyanide.

All hospitals stocked at least one of the four required antidotes for cyanide poisoning – an improvement compared with the previous audit which found that 4.6% hospitals did not.

The study authors, led by researchers from Guys’ and St Thomas’ NHS Foundation, warned that the variable availability of antidotes “has significant implications for the optimum management of poisoned patients”.

For example, they noted that cyanide poisoning antidotes were used in the management of critically unwell patients and delays in antidote administration “could result in mortality”.

“More work is required to ensure that those treating poisoned patients have timely access to antidotes”

Study authors

All category B antidotes – required within one hour by guidelines – were available in (17.6%) hospitals, and 62 (36.7%) of hospitals had all category B antidotes. For example, since 2010 there was an improvement in the stocking of fomepizole, which is recommended for toxic alcohol poisoning – up from 16.8% hospitals to 73.4% in the new audit.

However, the authors said: “There remains a small number with no appropriate antidote stocked for treating this important and potentially serious life threatening poisoning.”

Reasons for poor stocking include the high cost of some antidotes along with the need to replace those that may expire before use. However, these explanations do not account for activated charcoal which is relatively cheap and easily available, they said.

There was significant variability of the availability of category C antidotes – antidotes that are recommended to be stocked supra-regionally – even though this improved since the 2010 audit.

Sodium calcium edetate, suggested for lead poisoning, is a rare diagnosis but prompt treatment is required. Yet only 16.8% of hospitals stocked this antidote. Of those that did not, 44% were unable to provide information on where it could be sourced from.

More work is “urgently needed” to ensure hospitals have plans in place to source antidotes when required, said the authors in the European Journal of Hospital Pharmacy.

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