Combined evidence-based literature analysis and consensus guidelines for stocking of emergency antidotes in the United States.
OBJECTIVE
To develop guidelines for the stocking of antidotes at hospitals that accept emergency admissions using combined evidence-based and consensus methods.


METHODS
Study participants were 12 medical care providers from disciplines that are affected by insufficient stocking of emergency antidotes (clinical pharmacology, critical care, clinical pharmacy, emergency medicine, hospital pharmacy, internal medicine, managed care pharmacy, clinical toxicology, pediatrics, poison control centers, pulmonary medicine, regulatory medicine). Selection of individuals for the study panel was based on evidence of previous antidote research or perspective regarding the purchase and use of antidotes. The literature regarding each antidote was systematically amassed using pre-1966 literature files, current MEDLINE searches, the reference lists of major medical textbooks, and citations solicited from the consensus panel. Articles relevant to 4 defined core questions were included. These articles formed the basis of an evidence-based analysis performed by the principal investigator. After literature analysis, a literature summary and proposed guidelines for antidote stocking were submitted to the panel. Consensus was formed by electronic iterative presentation of alternatives to each panel member using a modified Delphi method. All panel members participated in 5 rounds of guideline analysis of 20 antidotes.


RESULTS
Of the 20 antidotes, 16 antidotes were ultimately recommended for stocking (N -acetylcysteine, atropine, Crotalid snake antivenin, calcium gluconate and chloride, cyanide antidote kit, deferoxamine, digoxin immune Fab, dimercaprol, ethanol, fomepizole, glucagon, methylene blue, naloxone, pralidoxime, physostigmine, sodium bicarbonate), 2 were not recommended for stocking (black widow antivenin, ethylenediamine tetraacetic acid), and consensus could not be reached for 2 antidotes (flumazenil, physostigmine).


CONCLUSIONS
These guidelines provide a tool to be used in revising or creating policies and procedures with regard to the stocking of antidotes in hospitals that accept emergency patients.
Richard C
RC
Dart
Lewis R
LR
Goldfrank
Peter A
PA
Chyka
Donna
D
Lotzer
Alan D
AD
Woolf
Jude
J
McNally
Wayne R
WR
Snodgrass
Kent R
KR
Olson
Elizabeth
E
Scharman
Robert J
RJ
Geller
Daniel
D
Spyker
Monica
M
Kraft
Robert
R
Lipsy
D000931:Antidotes / Q000191:economics / Q000592:standards* / Q000600:supply & distribution*; D004636:Emergency Service, Hospital / Q000592:standards*; D019317:Evidence-Based Medicine / Q000592:standards*; D017048:Health Care Costs; D006801:Humans; D017410:Practice Guidelines as Topic; D012680:Sensitivity and Specificity; D014481:United States
D000931:Antidotes