Expert Consensus Guidelines for Stocking of Antidotes in Hospitals That Provide Emergency Care
Study objective
We developed recommendations for antidote stocking at hospitals that provide emergency care.
Methods
An expert panel representing diverse perspectives (clinical pharmacology, clinical toxicology, critical care medicine, clinical pharmacy, emergency medicine, internal medicine, pediatrics, poison centers, pulmonary medicine, and hospital accreditation) 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 the quantity of an antidote that should be stocked and the acceptable period for delivery of each antidote.
Results
The panel recommended consideration of 24 antidotes for stocking. The panel recommended that 12 of the antidotes be available for immediate administration on patient arrival. In most hospitals, this period requires that the antidote be stocked in the emergency department. Another 9 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 identified additional antidotes that should be stocked by the hospital but are not usually needed within the first hour of treatment. The panel recommended that each hospital perform a formal antidote hazard vulnerability assessment to determine the need for antidote stocking in that hospital.
Conclusion
The antidote expert recommendations provide a tool to be used in creating practices for appropriate and adequate antidote stocking in hospitals that provide emergency care.
Supervising editors: Lewis S. Nelson, MD; Michael L. Callaham, MD
Dr. Nelson and Dr. Callaham were the supervising editors on this article. Dr. Dart did not participate in the editorial review or decision to publish this article.
Panel decisions: Panelists without a conflict of interest were eligible to vote on any issue. Panelists with conflicts were prohibited from voting on the drugs involved in the competing interest. The chair was nonvoting and disclosed that Denver Health's Rocky Mountain Poison and Drug Center is a nonprofit governmental facility that provides poison and drug information, and research and consulting services to various entities under contract.
Funding and support: By Annals policy, all authors are required to disclose any and all commercial, financial, and other relationships in any way related to the subject of this article, that might create any potential conflict of interest. See the Manuscript Submission Agreement in this issue for examples of specific conflicts covered by this statement. Complete disclosures can be found in Appendix E1, available online at http://www.annemergmed.com.
Publication date: Available online May 5, 2009.
Reprints not available from the authors.
PII: S0196-0644(09)00103-6
doi:10.1016/j.annemergmed.2009.01.023
© 2009 American College of Emergency Physicians. Published by Elsevier Inc. All rights reserved.
