title: Availability of antidotes at acute care hospitals in Ontario.
abstract: BACKGROUND
  Acutely poisoned patients sometimes require immediate treatment with an antidote, and delays in treatment can be fatal. We sought to determine the availability of 10 antidotes at acute care hospitals in Ontario.
  
  
  METHODS
  Mailed questionnaire with repeated reminders to pharmacy directors at all acute care hospitals in Ontario.
  
  
  RESULTS
  Responses were obtained from 179 (97%) of 184 hospitals. Only 9% of the hospitals stocked an adequate supply of digoxin immune Fab antibody fragments, a life-saving antidote for patients with severe digoxin toxicity, whereas most of the hospitals stocked sufficient supplies of ipecac syrup (88%) and flumazenil (92%), arguably the least crucial antidotes in the survey. Only 1 hospital stocked adequate amounts of all 10 antidotes. Certain hospital characteristics were associated with adequate antidote stocking (increased annual emergency department volume, teaching hospital status and designation as a trauma centre). Conversely, antidote supplies were particularly deficient at small hospitals and, paradoxically, geographically isolated facilities (those most reliant on their own inventory). The cost of antidotes correlated only weakly with stocking rates, and many examples of excessive antidote stocking were identified.
  
  
  CONCLUSIONS
  Most acute care hospitals in Ontario do not stock even minimally adequate amounts of several emergency antidotes, possibly jeopardizing the survival of an acutely poisoned patient. Much of this problem could be rectified at no additional cost by reducing excessive stock of expensive antidotes and redistributing the resources to acquire deficient antidotes.
authors.affiliation: Department of Medicine, University of Toronto, Canada. david.juurlink@ices.on.ca
authors.forename: D N
authors.initials: DN
authors.lastname: Juurlink
authors.forename: M A
authors.initials: MA
authors.lastname: McGuigan
authors.forename: T W
authors.initials: TW
authors.lastname: Paton
authors.forename: D A
authors.initials: DA
authors.lastname: Redelmeier
mesh_terms: D000931:Antidotes / Q000191:economics / Q000600:supply & distribution*; D016527:Drug Costs; D004636:Emergency Service, Hospital / Q000592:standards*; D006761:Hospitals / Q000592:standards*; D006801:Humans; D015999:Multivariate Analysis; D009864:Ontario; D011041:Poisoning / Q000628:therapy; D011795:Surveys and Questionnaires
chemical_list: D000931:Antidotes