title: Evidence-based, multidisciplinary approach to the development of a crotalidae polyvalent antivenin (CroFab) protocol at a university hospital.
abstract: BACKGROUND
  Several thousand people are bitten annually by venomous snakes in the US. While the development of ovine Crotalidae polyvalent immune Fab antivenin (FabAV) for Crotalinae snakebite envenomations has greatly changed the way this clinical presentation is treated, multiple issues complicate its use. From patient assessment and evaluation, to medication preparation and administration, to the management of adverse drug reactions, the use of this antidote carries with it multiple points of possible medication variances. The inappropriate use of this agent can result in adverse patient consequences and a significant financial burden for both the hospital and the patient.
  
  
  OBJECTIVE
  To describe an evidence-based, multidisciplinary approach that was taken to ensure optimal, safe, and cost-effective treatment of patients with FabAV.
  
  
  METHODS
  Following an analysis of the available literature, a multidisciplinary committee was formed to construct a protocol for use of FabAV. This group included clinical pharmacists, pharmacy administrators, emergency medicine physicians who specialized in wilderness medicine and pharmacy residents.
  
  
  RESULTS
  A multidisciplinary FabAV usage protocol was constructed and implemented to ensure appropriate patient evaluation, FabAV use and preparation, monitoring, and follow-up. This protocol was based on the available literature and the expert opinion of the committee. Through the use of a 24-hour in-house pharmacy resident on-call system, clinical pharmacy services were provided to ensure a multidisciplinary approach to the care of these patients emergently. Although limited, initial data show that this approach is effective and may result in substantial cost savings.
  
  
  CONCLUSIONS
  Initial results from implementation of a protocol for use of FabAV have limited inappropriate use, reduced medication wastage, and decreased costs.
authors.affiliation: Department of Pharmacy Services, University of Kentucky HealthCare, Lexington, KY 40536, USA. kawean2@email.uky.edu
authors.forename: Kyle A
authors.initials: KA
authors.lastname: Weant
authors.forename: Peter N
authors.initials: PN
authors.lastname: Johnson
authors.forename: Rebecca C
authors.initials: RC
authors.lastname: Bowers
authors.forename: John A
authors.initials: JA
authors.lastname: Armitstead
mesh_terms: D000997:Antivenins / Q000008:administration & dosage* / Q000191:economics; D002985:Clinical Protocols; D003362:Cost-Benefit Analysis; D003435:Crotalid Venoms / Q000037:antagonists & inhibitors; D019317:Evidence-Based Medicine / Q000379:methods*; D006785:Hospitals, University; D006801:Humans; D007140:Immunoglobulin Fab Fragments; D007128:Immunoglobulin Fragments / Q000008:administration & dosage* / Q000191:economics; D010607:Pharmacy Service, Hospital / Q000458:organization & administration; D012909:Snake Bites / Q000628:therapy; D014481:United States
chemical_list: D000997:Antivenins; D003435:Crotalid Venoms; C431183:Crotalidae Polyvalent immune Fab; D007140:Immunoglobulin Fab Fragments; D007128:Immunoglobulin Fragments