‘Do you know where your cyanide kit is?’: a study of perceived and actual antidote availability to emergency departments in the South West of England

Mitchell, Louisa; Higginson, Ian; Smith, Jessi L.; Swains, Liam; Farrant, Jennifer; Gagg, James; Lindenbaum, Charlotte; Mathieu, N

doi:10.1136/emermed-2012-201106

Cited by 5 publications

(2 citation statements)

References 5 publications

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“…Antidotes are an important tool in the management of poisoned patients, with timely administration being potentially lifesaving 1 2. Problems with availability of antidotes at the point of care have been reported worldwide with the potential for deleterious effects on patient outcomes 3–10. Guidance on antidote stocking is published in North America and the UK, and these emphasise the importance of timely availability 11–13.…”

Section: Introductionmentioning

confidence: 99%

National audit of antidote stocking in UK emergency departments

et al. 2019

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BackgroundPrevious audits of antidote stocking in UK hospitals have demonstrated variable but improving compliance with joint Royal College of Emergency Medicine and National Poisons Information Service guidance on antidote availability in emergency departments. The guidance was updated in 2017.AimTo provide a current picture of compliance with the 2017 antidote guidance and compare this to previous audits.MethodsQuestionnaires were distributed to all hospitals in the UK with an emergency department via medicines information and regional pharmacy procurement networks. Data were collected on availability and stock levels of category A (immediately available) and category B (available within 1 hour) antidotes. Additionally, data were collected on holdings of category C (held supra-regionally) antidotes and arrangements for sourcing these if not stocked locally.Results233 hospitals were surveyed and 178 replies (76.4%) were received. There were 73 hospitals (41.7%) fully compliant with guidance for category A, 34 hospitals (19.1%) for category B and 18 hospitals (10.1%) for both categories A and B antidotes. Few hospitals stocked category C antidotes (1.1%–34.8%). Evidence of formalised regional holding arrangements for category C antidotes, as advised in the guidance, was noted in some areas but many regions remain without such agreements.ConclusionsMost hospitals remain not fully compliant with stocking recommendations for categories A and B antidotes, with limited recent improvement. Category C antidotes are stocked by few hospitals although awareness of where these can be sourced appears to be increasing. Emergency departments should review their antidote stocking arrangements to ensure compliance with guidance. Formal arrangements for stocking of the more rarely used category C antidotes at a regional level are also required, where not already in existence, in order to assure their availability in an equitable way across the country.

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Section: Introductionmentioning

confidence: 99%

National audit of antidote stocking in UK emergency departments

et al. 2019

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“…1 Several studies have reported that hospital pharmacies have inadequate stocks of antidotes available. [2][3][4][5][6] Administration and dosing errors have also been reported in the literature. 7,8 With new dosing strategies being introduced, use in special populations, expanded indications for established antidotes, and the reassessment and expansion of off-label indications for other medications, knowledge of antidotes remains paramount.…”

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confidence: 99%

Before and after Study of Pharmacists' and Students' Knowledge of Two Novel Antidotes: High-Dose Insulin Euglycemia and Intravenous Fatty Acid Emulsion 20%

2015

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Purpose: To assess pharmacists' and students' knowledge of high-dose insulin euglycemia (HIE) and intravenous fatty acid emulsion 20% (IFE) and to see whether it improved after an educational intervention. Methods: A survey to assess the knowledge about the use of HIE and IFE as antidotes was e-mailed to practicing pharmacists, pharmacy residents, and students prior to and following an educational intervention. Fact sheets on the antidotes were developed in conjunction with the New York City Poison Control Center and were used as the educational intervention in this study. The impact of exposure to the intervention was measured by comparing the number of correct responses per question on the pre-and posttests and the mean pre-and posttest scores using chi-square and t tests, respectively. Results: Most respondents felt either not at all or only somewhat comfortable with managing a toxicologic emergency. There was a statistically significant difference in mean scores on the pretest and posttest (2.9 vs 5.45; P = .001) and for the number of participants giving correct responses for each question before and after education: 52.4% of respondents answered "I don't know" to the questions prior to education versus 21.2% after education (P < .001). Fewer respondents felt not at all comfortable managing a toxicologic emergency after the educational intervention (42.4 vs 50.3%; P < .001). Conclusion: Pharmacists and students reported little comfort in managing toxicological emergencies in general and have limited baseline knowledge about these agents. Educational interventions can significantly improve knowledge. Prior familiarity with these newer antidotes should reduce delays in their administration in an emergency.

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Cyanide Attack

Keim¹

2016

Ciottone's Disaster Medicine

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‘Do you know where your cyanide kit is?’: a study of perceived and actual antidote availability to emergency departments in the South West of England

Cited by 5 publications

References 5 publications

National audit of antidote stocking in UK emergency departments

National audit of antidote stocking in UK emergency departments

Before and after Study of Pharmacists' and Students' Knowledge of Two Novel Antidotes: High-Dose Insulin Euglycemia and Intravenous Fatty Acid Emulsion 20%

Cyanide Attack

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