Antidote Stocking at Hospitals in North Palestine

Abstract:

Objective: The purpose of this study
was to determine the availability and
adequacy of antidote stocking at
hospitals in north Palestine based on
published guidelines for antidote
stocking.

Methodology: This study is a cross
sectional survey of all hospitals at
north Palestine (n=11) using a
questionnaire which was completed by
the director of the pharmacy
department at each hospital. The
questionnaire was divided into 2 parts.
The first part contained a list of 25
antidotes while the second part
contained a list of 12 antidotes. This
classification is based on the guideline
proposed by the British Association for
Emergency Medicine (BAEM). The net
antidote stock results were compared
with the American guidelines as well.
Result: The overall availability of each
antidote in the first list varied widely
from zero for glucagon to 100% for
atropine. The number antidotes of the
first list that were stocked in the 11
hospitals ranged from 5 to 12
antidotes but none of the hospitals
stocked all the 25 antidotes.
Additionally, availability of antidotes in
the second list varied widely from zero
for polyethylene glycol to 100% for
dobutamine. The number of antidotes
stocked ranged from 5 to 9 but none of
the hospitals stocked all the 12
antidotes.

Discussion and Conclusion:
hospitals in north Palestine do not
have adequate stock of antidotes.
Raising awareness of the importance
of antidotes by education, regular
review of antidote storage, distribution
plans, and appropriate legislation
might provide solutions. Coordination
between Palestinian hospitals and the
PCDIC at An-Najah National University
is            also            important.

Key Words: Antidote, Hospital,
Palestine, Stocking, Poisoning.

Introduction:

Accidental and intentional poisoning
remains a major worldwide problem
which results in significant annual
morbidity and mortality.[1-4] In
general, decontamination followed by
supportive care have been regarded as
the essentials of clinical poisoning
management.[5] However, in certain
circumstances specific antidotes can
reduce morbidity, mortality, and the
duration of hospitalization.[3,5] The
prompt use of appropriate antidotes is
especially important in countries in
which high rates of poisoning do exist.
Over the past 20 years, many studies
have demonstrated that antidotes are
very essential and yet insufficiently
stocked in health care facilities.[6-14]
The precise cause of this problem is
unknown, but appears to be related to
limited hospital resources, cost and
possible unfamiliarity with
antidotes.[3,8]

The Joint Commission on Accreditation
of Healthcare Organizations requires
that hospitals stock antidotes, but
does not provide specific requirements
on the amounts. Several regional poi-
son control centers in the United State
and some textbooks have developed
recommendations for antidote stock-
ing.[3,8] In 2000, the first evidence-
based consensus guideline for stocking
antidotes in the United States was
published. These guidelines recom-
mended that 16 essential antidotes
should be stocked in each health care
facility that treats acutely poisoned pa-
tients.[15] Antidotes were considered
essential if they were both effective
and necessary within the first hour of
patient presentation. The quantity of
antidote recommended was based on
the dose necessary to treat one or two
70-kg acutely poisoned patients for the
first 4 hours.[15] In 2005, The British
Association for Emergency Medicine
(BAEM) and Guys & St Thomas' Poisons
Unit developed the first guidelines on
the stocking of antidotes. The BAEM
guideline has divided antidotes into
those that should be immediately
available in the emergency depart-
ment and those that should be avail-
able in the hospital for use within one
to four hours of poisoning.[16] The
BAEM guideline was having similarity

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