Availability of Antidotes in Kuwait: A National Audit

Availability of antidotes in Moroccan hospitals: a national survey

AIM

The lack of availability of antidotes is a challenge for hospitals all over the world. The objective of our study was to investigate the availability of antidotes in Moroccan hospitals.

METHODS

A cross-sectional, questionnaire-based study was conducted from November 2018 to April 2019. The questionnaire was sent to 25 hospitals in order to investigate the availability of 42 selected antidotes based on the International Programme on Chemical Safety list.

RESULTS

The survey response rate was 68%. Of the 42 selected antidotes, 38 (90.5%) were available depending on the hospitals included in the study. We found a strong correlation between the availability of antidotes and hospital bed capacity, and logistic regression analysis revealed that bed capacity is the only factor strongly associated with higher antidote stock levels. Some essential antidotes such as digoxin-specific antibody, protamine sulfate, flumazenil and glucagon were unavailable in many of the small- and medium-sized hospitals, and methylene blue, sodium nitroprussiate, Prussian blue and anti-snake venom were absent in all of the hospitals.

CONCLUSION

Despite the great efforts that have been made to improve the availability of antidotes in Morocco, some of these vital products are still lacking in Moroccan hospitals.

Optimization of antidote stocking, availability, and administration practices for a large multihospital organization

PURPOSE

Inadequate hospital antidote inventory is a widely documented international issue due to high medication costs, lack of emphasis on antidote importance, variable international standards, hospital size, and drug availability. A large health system underwent process and policy implementation for antidote stocking, availability tracking, and administration strategies to ensure appropriate inventory and improve patient safety.

SUMMARY

Process and policy implementation occurred over a 12-month period across the health system's 11 acute care hospitals with emergency department services. Opportunities for optimization were identified following data capture surrounding institution-specific antidote inventory and usage across the health system. Specifically, minimum par levels at each institution were determined from 2018 expert recommendations for both the central pharmacy and automated dispensing machines within the emergency department. These quantities ensured the availability of an antidote within a specific timeframe contingent on the acquisition acuity for at least one 100-kg patient. Entries for order sets, order statements, and smart pump drug libraries were modified or formulated to facilitate standardized practices and minimize safety errors before a system-wide electronic health record transition.

CONCLUSION

It is prudent for all institutions, independent or within a health system, to identify areas of improvement for antidote inventory and management. Implementation of a similar process for antidote stocking, sharing, and delivery at other institutions is feasible and necessary to mitigate issues with drug acquisition and timely administration.

Availability of Antidotes for Management of Acute Toxicity Cases at Emergency Departments in Qassim Hospitals: A Retrospective Study

Background: Drug overdose is a medico-social issue worldwide that may occur intentionally or unintentionally. It is one of the most common reasons for emergency department visits, and it is also a frequent cause of morbidity and mortality globally. This study aims to determine the occurrence of acute toxicity cases and their management outcomes at the emergency departments in Qassim Province hospitals in Saudi Arabia. In addition, the study aims to investigate the antidote availabilities at those medical centers.

Methods: A retrospective hospital record-based study of acute toxicity cases admitted to the emergency department in hospitals in Qassim during the period from January 1, 2020, to December 31, 2020, was conducted. Data were collected based on hospital resources such as gastrointestinal decontamination, stabilization, elimination enhancement resources, and antidotes from Qassim hospitals, and the availability of antidotes as well as the clinical data of the patients with the management outcome.

Results: A total of 264 patients with acute toxicity were admitted to the emergency departments of 14 hospitals in Qassim Province in 2020. Of the 264 cases, 179 (68%) were males, and 85 (32%) cases were females. Ninety-five percent of the cases were admitted to public hospitals, whereas 5% were admitted to private hospitals. The largest group by age of admitted cases were aged 11-20 years (19.3%). This study showed that 99% received appropriate treatment for their cause of toxicity, whereas 1% did not. The most common causes of toxicity in Qassim were found to be food poisoning (20.5%), followed by intentional suicide attempts with warfarin/enoxaparin/aspirin overdoses (15.9%) and acetaminophen (paracetamol) overdosage seen in 15.5% of admitted cases. Flagyl, in addition to fluids, was used in the management of 16.7% of cases, N-acetyl cysteine was used for 16.3%, and vitamins K and B6 were used for 14.0% of cases. Activated charcoal, atropine, calcium chloride, calcium gluconate, flumazenil, insulin, magnesium, sodium bicarbonate, and vitamin K were available at all the studied hospitals. However, all the hospitals lacked both ethylenediaminetetraacetic acid (EDTA) and a cyanide kit. Methylene blue and leucovorin were available in only one of the studied hospitals.

Expert consensus for a national essential antidote list: E-Delphi method

Antidote stocking represents a major challenge to hospitals all over the world, including Kuwait. In order to assist hospitals to reduce costs and improve patient care, an essential antidote list can be used as an initial foundation for securing sufficient antidote availability at healthcare institutions. The aim of our study is to generate a nationally relevant essential antidote list for emergency care hospitals in Kuwait using the e-Delphi method by establishing consensus through a multidisciplinary expert group of healthcare providers. An electronic survey with 47 essential antidotes was developed. The e-Delphi method was used, with three rounds of voting, to determine expert consensus on an essential antidote list for hospitals in Kuwait. A purposive sample of healthcare professionals from governmental and private hospitals were selected for this study (n = 30). Consensus was gained if ≥75% of the expert panel agreed on the inclusion of the antidote, without any strong disagreements. Round 1 of the e-Delphi resulted in 41 antidotes reaching consensus and seven new antidotes suggested by the expert panel. Round 2 had two antidotes (out of seven newly suggested ones) reaching consensus. Round 3 was a confirmatory round, where the expert group agreed on their previous rounds’ opinions. This resulted in the development of an essential antidote list with 43 antidotes. The optimal approach for ensuring adequate availability of antidotes is continuous monitoring of local poisoning incidence and antidote requirements through collaborations between academic researchers and emergency care clinicians. The development of an essential antidote list, with expert consensus, is one of the initial steps in securing a foundation for appropriate provision of antidotes at all healthcare institutions. This is the first study that the authors are aware of that demonstrates that the e-Delphi technique can consolidate recommendations of experts in emergency medicine to provide a list of essential antidotes.