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November 13, 1996

Insufficient Stocking of Poisoning Antidotes in Hospital Pharmacies

Author Affiliations

From the Rocky Mountain Poison and Drug Center, Denver Department of Health and Hospitals (Dr Dart, Ms Stark, and Mr Fulton), and Colorado Emergency Medicine Research Center, University of Colorado Health Sciences Center, Denver (Drs Dart and Lowenstein and Ms Koziol-McLain).

JAMA. 1996;276(18):1508-1510. doi:10.1001/jama.1996.03540180064034

Objective.  —To determine whether antidotes for poisoning and overdose are available in hospitals that provide emergency department care.

Design.  —Written survey of hospital pharmacy directors, each of whom reported the amount currently in stock of 8 different antidotes: antivenin (Crotalidae) polyvalent, cyanide kit, deferoxamine mesylate, digoxin immune Fab, ethanol, naloxone hydrochloride, pralidoxime chloride, and pyridoxine hydrochloride.

Participants.  —Pharmacy directors of all hospitals with emergency departments in Colorado, Montana, and Nevada.

Main Outcome Measures.  —Proportions of hospitals with insufficient stocking of each antidote, defined as complete lack of the antidote or an amount inadequate to initiate treatment of 1 seriously poisoned 70-kg patient.

Results.  —Questionnaires were mailed to 137 hospital pharmacy directors and 108 (79%) responded. Only 1 (0.9%) of the 108 hospitals stocked all 8 antidotes in adequate amounts. The rate of insufficient stocking for individual antidotes ranged from 2% (for naloxone) to 98% (for digoxin immune Fab). In a multiple regression analysis, smaller hospital size and lack of a formal review of antidote stocking were independent predictors of the number of antidotes stocked insufficiently.

Conclusions.  —Insufficient stocking of antidotes is a widespread problem in Colorado, Montana, and Nevada. Although these states are served by a certified regional poison center, potentially lifesaving antidotes are frequently not available when and where they might be needed to treat a single poisoned patient.