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CMAJ • July 10, 2001; 165 (1)
© 2001 Canadian Medical Association or its licensors

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Availability of antidotes at acute care hospitals in Ontario

David N. Juurlink*{ddagger}¶**, Michael A. McGuigan{dagger}, Thomas W. Paton§ and Donald A. Redelmeier*{ddagger}**

From the Departments of *Medicine and {dagger}Pediatrics, University of Toronto; {ddagger}the Clinical Epidemiology and Health Care Research Program and §Department of Pharmacy, Sunnybrook & Women's College Health Sciences Centre; ¶the Ontario Regional Poison Centre; and **the Institute for Clinical Evaluative Sciences, Toronto, Ont. At the time of writing, Dr. McGuigan was Medical Director of the Ontario Regional Poison Centre; he is now Medical Director of the Long Island Regional Poison Control Center, Winthrop University Hospital, Mineola, NY.

Correspondence to: Dr. David N. Juurlink, Sunnybrook & Women's College Health Sciences Centre, Rm. G-106, 2075 Bayview Ave., Toronto ON M4N 3M5; fax 416 480-6048; david.juurlink{at}ices.on.ca

Background: Acutely poisoned patients sometimes require immediate treatment with an antidote, and delays in treatment can be fatal. We sought to determine the availability of 10 antidotes at acute care hospitals in Ontario.

Methods: Mailed questionnaire with repeated reminders to pharmacy directors at all acute care hospitals in Ontario.

Results: Responses were obtained from 179 (97%) of 184 hospitals. Only 9% of the hospitals stocked an adequate supply of digoxin immune Fab antibody fragments, a life-saving antidote for patients with severe digoxin toxicity, whereas most of the hospitals stocked sufficient supplies of ipecac syrup (88%) and flumazenil (92%), arguably the least crucial antidotes in the survey. Only 1 hospital stocked adequate amounts of all 10 antidotes. Certain hospital characteristics were associated with adequate antidote stocking (increased annual emergency department volume, teaching hospital status and designation as a trauma centre). Conversely, antidote supplies were particularly deficient at small hospitals and, paradoxically, geographically isolated facilities (those most reliant on their own inventory). The cost of antidotes correlated only weakly with stocking rates, and many examples of excessive antidote stocking were identified.

Interpretation: Most acute care hospitals in Ontario do not stock even minimally adequate amounts of several emergency antidotes, possibly jeopardizing the survival of an acutely poisoned patient. Much of this problem could be rectified at no additional cost by reducing excessive stock of expensive antidotes and redistributing the resources to acquire deficient antidotes.




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Cost of adequate antidote availability
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CMAJ, 11 Jul 2001 [Full text]