Hospitals fail to follow antidote stock rules, audit finds

7 December 2015

Procurement guidelines on stocking antidotes required for immediate use are being followed in less than a fifth of hospitals in England, Wales and Northern Ireland.

An audit published in the European Journal of Hospital Pharmacy found only 17.6 per cent of hospitals in England, Wales and Northern Ireland stock all of the recommended antidotes for immediate use in emergency departments.

The guidelines recommending which antidotes should be stocked and ready for immediate use were revised in 2013 by The Royal College of Emergency Medicine and National Poisons Information Service. This followed a 2010 audit found significant variations in stocking of antidotes.

The recent audit questioned chief pharmacists of 215 acute hospitals about antidote availability. Questions aimed to ascertain whether recommended antidotes were kept in stock and if not, how quickly the medicines could be sourced. Some 17.6 per cent of hospitals stocked every category A antidote – antidotes required for immediate use in the emergency department for treatment of poisoning with drugs such as paracetamol, opioid painkillers, and chemicals such as cyanide.

Only 36.7 per cent of hospitals held all category B antidotes – which should be available within one hour according to guidelines stocked in the hospital. There were some substantial improvements. Fomepizole, for example, an important drug for treating toxic alcohol poisoning, was stocked by 16.8 per cent of hospitals in 2010 but 73.4 per cent of hospitals in the current audit.

However the authors of the study said: "There remains a small number with no appropriate antidote stocked for treating this important and potentially serious life threatening poisoning."

Kevan Wind, a specialist procurement pharmacist and contributor to the report, said: “Some of these medicines are quite rare and quite difficult to get hold of but the trusts have sourcing information for each of the products. If they’re not stocking the products I’m not quite sure why that is.”

He said it might be because they perceived risks from certain kinds of poisoning to be low in their coverage areas, for example a hospital covering a predominantly urban area might consider risks from pesticide poisoning to be relatively insignificant. Reasons for poor stocking include the high cost of some antidotes along with the need to replace stock, which may expire before use.

“I don’t think it’s the case that purchasing departments don’t know where to get the products from,” said Wind.

He said that in the case of some products, such as adder antivenom, the supply chain was complex but there was information on how to obtain it.

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