Document Type: Original Article

Authors

1 clinical pharmacist in emergency department in Hamad General Hospital

2 Emergency Consultant/ Hamad General Hospita;Department of Emergency Medicine

3 Research Assisstant, Hamad General Hospital-Department of Emergency Medicine

4 Pharmacy Technicion/ Hamad General Hospital-Department of Pharmacy

5 pharmacist/Hamad General Hospital-Department of pharmacy

6 Quality Reviewer/Hamad General Hospital-Emergency Department

7 Emergency Consultant/Hamad General Hospital-Emergency Department

8 Associate Clinical Professor of Emergency Medicine Albert Einstein College of Medicine Bronx, New York

Abstract

Background
Few studies evaluating preparedness and availability of antidotes in the emergency setting exist and none have been conducted in Qatar. To address this; we conducted a study to evaluate antidote stocking and utilization in Qatar hospital pharmacies and emergency departments.
Methods
Our aim was: 1) evaluate the appropriate use and timely administration of antidotes, and; 2) evaluate stocking of the 31 most important antidotes our main public hospitals. For the evaluation of the first aim; research assistants prospectively collected data on ED patients who received any key antidote over the 6-month study period using both ED and pharmacy records. For the second aim; survey assessing stocking of these key antidotes was sent to the four general hospitals in Qatar to determine their availability and whether they are stocked in the ED or only in the main pharmacy.

Results
Poison exposure in 471 cases were evaluated. Antidotes were given within 30 minutes in 73% of cases, which included atropine, calcium, dextrose, flumazenil, naloxone, pralidoxime, sodium bicarbonate, thiamine, vitamin K and scorpion and snake antivenoms. Administration occurred later than 60 minutes in 2% of cases, exclusively with N-acetylecysteine and activated charcoal. Atropine,dextrose, naloxone, pralidoxime (2-PAM), sodium bicarbonate, and anti-venoms were clinically indicated 92% of the time they were ordered. N-acetylcysteine was indicated in only 51.5% of administrations.
Conclusion
Over 90% of antidotes were administered in less than 30 minutes. N-acetylcysteine administration was frequently delayed due to preparation outside of the ED. This delay of administration did not have any adverse effect on clinical management. Antidote stocking varied significantly between hospitals and antidotes necessary for cyanide and toxic alcohol poisoning were deficient in all public hospitals. The implication indicates the need for the development of national guidelines to standardize the stocking and administration of the antidotes among the country public hospitals.

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