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Eljaoudi R, Moutaouakkil Y, Adouani B, Tadlaoui Y, Boukria S, Ait El Cadi M, Lamsaouri J, Bousliman Y. Availability of antidotes in Moroccan hospitals: a national survey. Eur J Hosp Pharm 2023; 30:172-176. [PMID: 34183454 PMCID: PMC10176993 DOI: 10.1136/ejhpharm-2021-002842] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Accepted: 06/08/2021] [Indexed: 11/04/2022] Open
Abstract
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.
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Affiliation(s)
- Rachid Eljaoudi
- Pharmacology and Toxicology Department, Faculty of Medicine and Pharmacy, Rabat Institute University Mohamed V, Rabat, Morocco
| | - Youssef Moutaouakkil
- Pharmacology and Toxicology Department, Faculty of Medicine and Pharmacy, Rabat Institute University Mohamed V, Rabat, Morocco
| | - Badr Adouani
- Pharmacology and Toxicology Department, Faculty of Medicine and Pharmacy, Rabat Institute University Mohamed V, Rabat, Morocco
| | - Yasmina Tadlaoui
- Laboratory of Medicinal Chemistry, Faculty of Medicine and Pharmacy, Rabat Institute University Mohamed V, Rabat, Morocco
| | - Sofia Boukria
- Pharmacology and Toxicology Department, Faculty of Medicine and Pharmacy, Rabat Institute University Mohamed V, Rabat, Morocco
| | - Mina Ait El Cadi
- Pharmacology and Toxicology Department, Faculty of Medicine and Pharmacy, Rabat Institute University Mohamed V, Rabat, Morocco
| | - Jamal Lamsaouri
- Laboratory of Medicinal Chemistry, Faculty of Medicine and Pharmacy, Rabat Institute University Mohamed V, Rabat, Morocco
| | - Yasser Bousliman
- Pharmacology and Toxicology Department, Faculty of Medicine and Pharmacy, Rabat Institute University Mohamed V, Rabat, Morocco
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Abu Esba LC, Mardawi G, Al Deeb M. Can't find the antidote: A root cause analysis. Front Pharmacol 2022; 13:895841. [PMID: 36147314 PMCID: PMC9488554 DOI: 10.3389/fphar.2022.895841] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Accepted: 07/22/2022] [Indexed: 11/13/2022] Open
Abstract
Background: In a series of cases that came to be recognized as a national methanol outbreak, an incident of delay in allocation and treatment with the antidote fomepizole is described with aim of sharing a learning experience. Method: A team of 16 members was formed to conduct a Root Cause Analysis (RCA), which included multiple individual interviews with the stakeholders and inspection visits to the area. Results: Root causes: The restocking process was unclear and inconsistent and specifically lacked a restocking policy for antidotes, inappropriate labeling and area design, and a sound-alike between fomepizole and omeprazole. Contributing factors included: unsuitable restocking practice and lack of training in using the pharmaceutical electronic inventory system. Corrective actions were recommended and implemented. Conclusion: Management of antidotes in large healthcare systems requires a team effort to ensure appropriate and timely availability in emergency poisoning cases. This RCA identified important areas for improvement that could be insightful to other institutions in preventing similar vulnerabilities and is unique in describing the details of system improvements that can have a large impact on patient safety.
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Affiliation(s)
- Laila Carolina Abu Esba
- King Abdulaziz Medical City, Ministry of National Guard, Health Affairs, Riyadh, Saudi Arabia
- King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
- King Abdullah International Medical Research Centre, Riyadh, Saudi Arabia
| | - Ghada Mardawi
- King Abdullah International Medical Research Centre, Riyadh, Saudi Arabia
- Pharmaceutical Care Services, King Abdulaziz Medical, Riyadh, Saudi Arabia
| | - Mohammad Al Deeb
- King Abdullah International Medical Research Centre, Riyadh, Saudi Arabia
- Department of Emergency Medicine, Medical Toxicology division, King Abdulaziz Medical City, Riyadh, Saudi Arabia
- College of medicine, King Saud Bin Abdulaziz University for Health Sciences, King Abdullah International Medical Research Centre, Riyadh, Saudi Arabia
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Expert consensus for a national essential antidote list: E-Delphi method. PLoS One 2022; 17:e0269456. [PMID: 35709136 PMCID: PMC9202922 DOI: 10.1371/journal.pone.0269456] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2021] [Accepted: 05/20/2022] [Indexed: 11/19/2022] Open
Abstract
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.
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Achouri MY, Chaïb H, Benattou M, Zebbiche Y, Selka MA, Benhaddou IA, Chelghoum M. Disponibilité des antidotes dans les établissements de santé en Algérie : enquête nationale. TOXICOLOGIE ANALYTIQUE ET CLINIQUE 2022. [DOI: 10.1016/j.toxac.2021.11.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Kifle ZD, Yimenu DK, Demeke CA, Kasahun AE, Siraj EA, Wendalem AY, Bazezew ZA, Mekuria AB. Availability of Essential Antidotes and the Role of Community Pharmacists in the Management of Acute Poisoning: A Cross-Sectional Study in Ethiopia. INQUIRY: THE JOURNAL OF HEALTH CARE ORGANIZATION, PROVISION, AND FINANCING 2022; 59:469580211062449. [PMID: 35114845 PMCID: PMC8819777 DOI: 10.1177/00469580211062449] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/03/2022]
Abstract
Background Morbidity and mortality related to acute poisoning is a major public health
issue in both developing and developed countries. Community pharmacists have
a crucial role in ensuring drug availability, increasing drug safety,
counseling patients, overdose risk reduction and management, and provision
of appropriate drug information. This study aimed to assess the availability
of necessary antidotes in community pharmacies in Gondar and Bahir-Dar
cities, Ethiopia, and the role of community pharmacists in the management of
acute poisoning. Methods A cross-sectional survey was conducted in Gondar and Bahir-Dar cities. A
self-administered, structured questionnaire was used for data collection and
Statistical Package for Social Sciences (SPSS) version 24.0 was used for
data analysis. Chi-square analysis was computed to identify the associated
factors with a confidence interval of 95% and a P value
less than .05 was used as a cut-point for statistical significance. Results Out of 101 community pharmacies invited to participate in the study, 80 of
them completed the survey with a response rate of 79.2%. The overall mean
antidote availability score was .59 (SD = .837), which falls within the
definition of Poor availability. None of the pharmacies had kept all of the
antidotes, and the maximum number of an antidote kept by a single pharmacy
was 7 out of nineteen essential antidotes surveyed. The most commonly
reported reason for the unavailability of essential antidotes was stock was
not ordered (56.3%) followed by stock ordered but not delivered from
suppliers (wholesalers) (20.0%). More than 3 fourth of the respondents
(83.8%) had poor knowledge about the antidotes for the common
poisonings. Conclusion There was a significantly very low availability of essential antidotes in the
community pharmacies. Strategies should be implemented to improve
pharmacist’s knowledge about antidotes, and management of poisoning
emergencies through on-job training and provision of reference
materials.
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Affiliation(s)
- Zemene Demelash Kifle
- Department of Pharmacology, School of Pharmacy, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Dawit Kumilachew Yimenu
- Department of Pharmaceutics and Social Pharmacy, School of Pharmacy, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Chilot Abiyu Demeke
- Department of Pharmaceutics and Social Pharmacy, School of Pharmacy, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Asmamaw Emagn Kasahun
- Department of Pharmaceutics and Social Pharmacy, School of Pharmacy, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Ebrahim Abdela Siraj
- Department of Pharmacognosy, College of Medicine and Health Sciences, Bahir Dar University, Bahir Dar, Ethiopia
| | - Adane Yehualaw Wendalem
- Department of Pharmaceutics, College of Medicine and Health Sciences, Bahir Dar University, Bahir Dar, Ethiopia
| | - Zegaye Agmassie Bazezew
- Department of Medicinal Chemistry, College of Medicine and Health Sciences, Bahir Dar University, Bahir Dar, Ethiopia
| | - Abebe Basazn Mekuria
- Department of Pharmacology, School of Pharmacy, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
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Dandona R, Gunnell D. Pesticide surveillance and deaths by suicide. LANCET GLOBAL HEALTH 2021; 9:e738-e739. [PMID: 33901425 DOI: 10.1016/s2214-109x(21)00174-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Accepted: 03/23/2021] [Indexed: 11/28/2022]
Affiliation(s)
- Rakhi Dandona
- Public Health Foundation of India, Gurugram 122 002, India; Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA.
| | - David Gunnell
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
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Al-Taweel D, Al-Haqan A, Qabazard B, Abuzainah D, Koshy S, Alqenae F, Ali S, Abahussain E. Availability of Antidotes in Kuwait: A National Audit. J Emerg Med 2020; 58:305-312. [DOI: 10.1016/j.jemermed.2019.11.016] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2019] [Revised: 10/27/2019] [Accepted: 11/10/2019] [Indexed: 02/04/2023]
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Expert Consensus Guidelines for Stocking of Antidotes in Hospitals That Provide Emergency Care. Ann Emerg Med 2018; 71:314-325.e1. [DOI: 10.1016/j.annemergmed.2017.05.021] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2017] [Revised: 05/08/2017] [Accepted: 05/15/2017] [Indexed: 11/20/2022]
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Broto-Sumalla A, Rabanal-Tornero M, García-Peláez M, Aguilar-Salmerón R, Fernández de Gamarra-Martínez E, Martínez-Sánchez L, Gaspar-Caro MJ, Nogué-Xarau S. Availability of antidotes in 70 hospitals in Catalonia, Spain. Med Clin (Barc) 2018; 150:16-19. [PMID: 28705416 DOI: 10.1016/j.medcli.2017.05.037] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2017] [Revised: 05/17/2017] [Accepted: 05/18/2017] [Indexed: 11/24/2022]
Abstract
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.
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Affiliation(s)
- Antoni Broto-Sumalla
- Servicio de Farmacia, Consorci Sanitari de Terrassa, Terrassa, Barcelona, España
| | - Manel Rabanal-Tornero
- Direcció General d'Ordenació Professional i Regulació Sanitària, Departament de Salut, Generalitat de Catalunya
| | - Milagros García-Peláez
- Servicio de Farmacia, Hospital de Sabadell, Institut Universitari Parc Taulí-Universidad Autónoma de Barcelona, Sabadell, España
| | | | | | | | - María-José Gaspar-Caro
- Direcció General d'Ordenació Professional i Regulació Sanitària, Departament de Salut, Generalitat de Catalunya
| | - Santiago Nogué-Xarau
- Secció de Toxicología Clínica, Área de Urgencias, Hospital Clínic, Barcelona, España; Grupo de Investigación Urgencias procesos y patologías, IDIBAPS, Barcelona, España.
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A system-wide solution to antidote stocking in emergency departments: the Nova Scotia antidote program. CAN J EMERG MED 2017; 21:37-46. [PMID: 28927481 DOI: 10.1017/cem.2017.400] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
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.
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Mansour A, Al-Bizri L, El-Maamary J, Al-Helou A, Hamade R, Saliba E, Khammash D, Makhoul K, Matli K, Ghosn N, Deeb M, Faour WH. National study on the adequacy of antidotes stocking in Lebanese hospitals providing emergency care. BMC Pharmacol Toxicol 2016; 17:51. [PMID: 27817746 PMCID: PMC5098286 DOI: 10.1186/s40360-016-0092-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2016] [Accepted: 09/29/2016] [Indexed: 12/01/2022] Open
Abstract
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. Electronic supplementary material The online version of this article (doi:10.1186/s40360-016-0092-7) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Anthony Mansour
- School of Medicine, Lebanese American University, P.O. Box 36, Byblos, Lebanon
| | - Layla Al-Bizri
- School of Medicine, Lebanese American University, P.O. Box 36, Byblos, Lebanon
| | - Jad El-Maamary
- School of Medicine, Lebanese American University, P.O. Box 36, Byblos, Lebanon
| | - Amanda Al-Helou
- School of Medicine, Lebanese American University, P.O. Box 36, Byblos, Lebanon
| | - Rayan Hamade
- School of Medicine, Lebanese American University, P.O. Box 36, Byblos, Lebanon
| | - Elie Saliba
- School of Medicine, Lebanese American University, P.O. Box 36, Byblos, Lebanon
| | - Dina Khammash
- School of Medicine, Lebanese American University, P.O. Box 36, Byblos, Lebanon
| | - Karim Makhoul
- School of Medicine, Lebanese American University, P.O. Box 36, Byblos, Lebanon
| | - Kamal Matli
- School of Medicine, Lebanese American University, P.O. Box 36, Byblos, Lebanon
| | - Nada Ghosn
- Lebanese Ministry of Public Health, Beirut, Lebanon
| | - Mary Deeb
- School of Medicine, Lebanese American University, P.O. Box 36, Byblos, Lebanon
| | - Wissam H Faour
- School of Medicine, Lebanese American University, P.O. Box 36, Byblos, Lebanon. .,School of Medicine, Room 4722, Lebanese American University, P.O. Box 36, Byblos, Lebanon.
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Liu Y, Zhu H, Walline J, Wang M, Xu Q, Li Y, Yu X. The mastery of antidotes: A survey of antidote knowledge and availability among emergency physicians in registered hospitals in China. Hum Exp Toxicol 2016; 35:462-71. [PMID: 27022164 DOI: 10.1177/0960327116639364] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
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.
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Affiliation(s)
- Y Liu
- Emergency Department, Peking Union Medical College Hospital, Beijing, China
| | - H Zhu
- Emergency Department, Peking Union Medical College Hospital, Beijing, China
| | - J Walline
- Department of Emergency Medicine, Saint Louis University, Saint Louis, United States
| | - M Wang
- Department of Epidemiology and Biostatistics, Peking Union Medical College, Beijing, China
| | - Q Xu
- Department of Epidemiology and Biostatistics, Peking Union Medical College, Beijing, China
| | - Y Li
- Emergency Department, Peking Union Medical College Hospital, Beijing, China
| | - X Yu
- Emergency Department, Peking Union Medical College Hospital, Beijing, China
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Zyoud SH, Al-Jabi SW, Bali YI, Al-Sayed AM, Sweileh WM, Awang R. Availability of treatment resources for the management of acute toxic exposures and poisonings in emergency departments among various types of hospitals in Palestine: a cross-sectional study. Scand J Trauma Resusc Emerg Med 2014; 22:13. [PMID: 24555427 PMCID: PMC3939642 DOI: 10.1186/1757-7241-22-13] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2013] [Accepted: 02/17/2014] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Poisoning exposures continue to be a significant cause of morbidity and mortality worldwide. The lack of facilities, treatment resources, and antidotes in hospitals may affect the treatments provided and outcomes. This study aimed to determine the availability of gastrointestinal (GI) decontamination, stabilisation, elimination enhancement resources, and antidotes for the management of acute toxic exposures and poisonings in emergency departments (EDs) among various types of governmental and private hospitals in Palestine. METHODS A cross-sectional study using semi-structured questionnaire was performed. Data were collected based on hospital resources; GI decontamination, stabilisation, elimination enhancement resources and antidotes from Palestinian hospitals. RESULTS Eighteen hospitals (94.7%) have responded. Among them, paracetamol poisoning was the most frequently reported cases by EDs (mean frequency score = 7.6 ± 2.1), followed by bee stings (mean = 6.9 ± 2.7) and organophosphate poisoning (mean = 6.7 ± 2.7). The availabilities of most resources related to GI decontamination items varied substantially with hospital type, but these differences were not statistical significant. The availability of stabilisation resources was not significantly different between hospitals types. For the availability of techniques used to enhance the elimination of toxic substances, there were variations between the hospitals types. However, these differences were not statistical significant, except for haemodialysis (p = 0.003) which was more available in governmental hospitals. For the availability of antidotes, none of the hospitals had sufficient stock of all antidotes listed. In relation to hospital type, there was variability in the availability of antidotes, but this did not reach statistical significance, except for deferoxamine (p < 0.001), which was available in all governmental hospitals but none of the private hospitals. CONCLUSIONS The availability of treatment resources and antidotes in Palestinian hospitals was not adequate except for stabilisation resources. The availability of such resources acts as a marker for the level of readiness of hospital EDs in Palestine for the management of acute toxic exposure and poisoning. The implementation of a minimum list of antidotes and treatment resources would be useful to increase the level of resources. Coordination between Palestinian poison control and drug information centre and hospitals is also important.
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Affiliation(s)
- Sa’ed H Zyoud
- Poison Control and Drug Information Center (PCDIC), College of Medicine and Health Sciences, An-Najah National University, Nablus, Palestine
- Department of Pharmacology and Toxicology, College of Medicine and Health Sciences, An-Najah National University, Nablus, Palestine
- WHO Collaborating Centre for Drug Information, National Poison Centre, Universiti Sains Malaysia (USM), Penang, Malaysia
| | - Samah W Al-Jabi
- Department of Clinical and Comunity Pharmacy, College of Medicine and Health Sciences, An-Najah National University, Nablus, Palestine
| | - Yara I Bali
- PharmD Program, College of Medicine and Health Sciences, An-Najah National University, Nablus, Palestine
| | - Afnan M Al-Sayed
- PharmD Program, College of Medicine and Health Sciences, An-Najah National University, Nablus, Palestine
| | - Waleed M Sweileh
- Department of Pharmacology and Toxicology, College of Medicine and Health Sciences, An-Najah National University, Nablus, Palestine
| | - Rahmat Awang
- WHO Collaborating Centre for Drug Information, National Poison Centre, Universiti Sains Malaysia (USM), Penang, Malaysia
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Awang R, Al-Sohaim SI, Zyoud SH, Khan HRM, Hashim S. Availability of decontamination, elimination enhancement, and stabilization resources for the management of acute toxic exposures and poisonings in emergency departments in Malaysia. Intern Emerg Med 2011; 6:441-8. [PMID: 21750875 DOI: 10.1007/s11739-011-0662-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2011] [Accepted: 06/29/2011] [Indexed: 02/07/2023]
Abstract
Acute poisoning is a common medical emergency in Malaysia. Life can be saved if the patient is diagnosed properly and receives the appropriate treatment such as gastrointestinal decontamination techniques and resources to increase poison elimination according to clinical guidelines at a reasonable time. The aims of this study were to determine the availability of decontamination, elimination enhancement, and stabilization resources for the management of acute toxic exposures and poisonings in accident and emergency departments in Malaysia, and to compare the availability of such facilities among various types of hospitals. A comparative, descriptive cross-sectional study was conducted using a structured questionnaire. Seventy-four (58.3%) out of the targeted 127 hospitals replied and completed the questionnaire. The availabilities of most items related to stabilization resources were far better in general hospitals compared to district hospitals with specialists and district hospitals without specialists. These items were mechanical ventilators (p = 0.011), non-invasive positive pressure ventilators (0.024), pacemakers (p = 0.019), and transcutaneous cardiac pacing (p < 0.001). The availability of decontamination resources varied substantially with hospital type. Nevertheless, these differences did not reach statistical significance in any of the cases, whereas sodium sulphate, sorbitol, and polyethylene glycol were almost never available. The availabilities of most items related to elimination enhancement resources were far better in general hospitals and district hospitals with specialists compared to district hospitals without specialists. These items were haemodialysis (p = 0.046), haemoperfusion (p = 0.002), haemofiltration (p = 0.002), acid diuresis (p = 0.04), peritoneal dialysis (p < 0.001), and exchange transfusion (p < 0.001). Most Malaysian hospitals have certain important immediate interventions such as gastrointestinal decontamination techniques and resources to increase poison elimination. The availabilities of most facilities were far better in the general hospitals. Coordination between the National Poison Centre in Malaysia and hospitals should be established regarding the emergency facilities for effective management of poisoning cases in each hospital in order to direct the poisoned patients to the hospital where the appropriate management resources is available.
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Affiliation(s)
- Rahmat Awang
- WHO Collaborating Centre for Drug Information, Clinical Toxicology Program, National Poison Centre, Universiti Sains Malaysia (USM), 11800 Penang, Malaysia.
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