Introduction: Previous studies have demonstrated that antidotes are insufficiently stocked in Canadian and US health care facilities. The purpose of this study was to determine the adequacy of antidote stocking in British Columbia hospitals based on the current guidelines.
Methods: A written survey was mailed to hospital pharmacy directors at all 93 acute care facilities in BC. Availability of 14 essential antidotes was classified as sufficient or insufficient based on the current guidelines. Facilities were stratified into small (<50 beds), medium (50-250 beds) or large (>250 beds); teaching or non-teaching; trauma or non-trauma, urban or rural, and isolated or non-isolated.
Results: Complete responses were received from 75 (81%) of 93 hospitals. No hospital had adequate stock of all 14 antidotes. Overall, the average number (+/- standard deviation) of antidotes adequately stocked was 4.2 +/- 2.9 per hospital. Urban hospitals had adequate stocks of 6.5 +/- 2.6 antidotes while rural centres had adequate stocks of 2.6 +/- 1.8 (p < 0.001). Corresponding figures were 9.0 +/- 1.8 for teaching hospitals vs. 3.7 +/- 2.4 for non-teaching hospitals (p < 0.001), 8.9 +/- 2.0 for trauma centres vs. 3.8 +/- 2.5 non-trauma centres (p < 0.001), and 2.5 +/- 2.1 for isolated hospitals vs. 4.6 +/- 2.9 for non-isolated hospitals (p = 0.018). Small, medium, and large hospitals adequately stocked 2.3 +/- 1.7, 5.7 +/- 2.2, and 7.7 +/- 3.0 antidotes, respectively (p < 0.001). The 4 antidotes most adequately stocked were sodium bicarbonate (77%), N-acetylcysteine (64%), ethanol (49%) and naloxone (47%). Digoxin immune Fab fragments, glucagon, pyridoxine and rattlesnake antivenin were poorly stocked with sufficient supplies of 5%, 7%, 7% and 13%, respectively.
Conclusion: BC hospitals do not have adequate antidote stocks. Provincial stocking guidelines and coordination of antidote purchasing and stocking are necessary to correct these deficiencies.