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Annals of Emergency Medicine

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Expert Consensus Guidelines for Stocking of Antidotes in Hospitals That Provide Emergency Care - 21/02/18

Doi : 10.1016/j.annemergmed.2017.05.021 
Richard C. Dart, MD, PhD a, Lewis R. Goldfrank, MD b, Brian L. Erstad, PharmD c, David T. Huang, MD, MPH d, Knox H. Todd, MD, MPH e, Jeffrey Weitz, MD f, Vikhyat S. Bebarta, MD g, E. Martin Caravati, MD, MPH h, Fred M. Henretig, MD i, Theodore R. Delbridge, MD, MPH j, William Banner, MD, PhD k, Sandra M. Schneider, MD l, Victoria E. Anderson, MPH a, ⁎
a Rocky Mountain Poison and Drug Center, Denver Health and Hospital Authority, Denver, CO 
b Ronald O. Perelman Department of Emergency Medicine, New York University School of Medicine, New York, NY 
c Department of Pharmacy Practice and Science, the University of Arizona College of Pharmacy, Tucson, AZ 
d Multidisciplinary Acute Care Research Organization Center, Departments of Critical Care and Emergency Medicine, University of Pittsburgh, Pittsburgh, PA 
e EMLine, Mendoza, Argentina 
f Thrombosis and Atherosclerosis Research Institute, Hamilton General Hospital, Hamilton, Ontario, Canada 
g Department of Emergency Medicine, Section of Medical Toxicology, University of Colorado School of Medicine, Aurora, CO 
h Division of Emergency Medicine, University of Utah School of Medicine, Salt Lake City, UT 
i Department of Pediatrics, Division of Emergency Medicine, Children’s Hospital of Philadelphia, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 
j Department of Emergency Medicine, East Carolina University, Greenville, NC 
k Oklahoma Center for Poison and Drug Information, College of Pharmacy, University of Oklahoma, Oklahoma City, OK 
l Department of Emergency Medicine, Hofstra Northwell School of Medicine, Hempstead, NY 

∗Corresponding Author.

Abstract

We provide recommendations for stocking of antidotes used in emergency departments (EDs). An expert panel representing diverse perspectives (clinical pharmacology, medical toxicology, critical care medicine, hematology/oncology, hospital pharmacy, emergency medicine, emergency medical services, pediatric emergency medicine, pediatric critical care medicine, poison centers, hospital administration, and public health) 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 both the quantity of antidote that should be stocked and the acceptable timeframe for its delivery. The panel recommended consideration of 45 antidotes; 44 were recommended for stocking, of which 23 should be immediately available. In most hospitals, this timeframe requires that the antidote be stocked in a location that allows immediate availability. Another 14 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 recommended that each hospital perform a formal antidote hazard vulnerability assessment to determine its specific need for antidote stocking. Antidote administration is an important part of emergency care. These expert recommendations provide a tool for hospitals that offer emergency care to provide appropriate care of poisoned patients.

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 Supervising editor: Matthew D. Sztajnkrycer, MD, PhD
 Authorship: All authors attest to meeting the four ICMJE.org authorship criteria: (1) Substantial contributions to the conception or design of the work; or the acquisition, analysis, or interpretation of data for the work; AND (2) Drafting the work or revising it critically for important intellectual content; AND (3) Final approval of the version to be published; AND (4) Agreement to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.
 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 as per ICMJE conflict of interest guidelines (see www.icmje.org/). Funding for this research was provided by BTG International Inc., Boehringer Ingelheim, Rare Disease Therapeutics, and Cumberland Pharmaceuticals to Denver Health and Hospital Authority. Dr. Todd reports receiving consulting fees from Kaleo. Dr. Weitz reports receiving consulting fees from Boehringer Ingelheim. Dr. Bebarta reports receiving consulting fees from BTG International Inc. Dr. Banner reports receiving consulting fees from BTG International Inc. and Pfizer.
 The funding sponsors had no input into the design, definitions, panel proceedings, analysis of the results, or drafting of the article. Rocky Mountain Poison and Drug Center–Denver Health is a nonprofit governmental facility that provides poison and drug information, research, and consulting services to various entities under contract. Clients of the center include a variety of governmental, nongovernmental, and commercial organizations. In addition to the funding sponsors of the Antidote Summit, these include Johnson & Johnson, Pfizer, and Purdue Pharma.
 A podcast for this article is available at www.annemergmed.com.


© 2017  American College of Emergency Physicians. Publié par Elsevier Masson SAS. Tous droits réservés.
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Vol 71 - N° 3

P. 314 - mars 2018 Retour au numéro
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