title: Safety and cost-effectiveness of a clinical protocol implemented to standardize the use of Crotalidae polyvalent immune Fab antivenom at an academic medical center.
abstract: OBJECTIVE
  To evaluate the safety and cost-effectiveness of a clinical protocol adopted in June 2006 that included a comprehensive, objective assessment of snake bite envenomations and standardized the use of Crotalidae polyvalent immune Fab antivenom (FabAV).
  
  
  METHODS
  Retrospective medical record review.
  
  
  METHODS
  Academic medical center that serves as the regional level I trauma center.
  
  
  METHODS
  Seventy-five adults treated with FabAV for snake envenomations in the emergency department between June 1, 2003, and June 1, 2009; 30 patients received treatment according to the protocol (treatment group), and 45 patients received treatment that did not adhere to the protocol (control group).
  
  
  RESULTS
  Demographic and envenomation characteristics, as well as treatment details, were collected for all patients. In addition, information on quantity of FabAV vials required, length of hospital stay, and length of intensive care unit stay were compared between the treatment and control groups. In the treatment group, significantly fewer vials of FabAV were used (2.5 vs 4.727 vials, p=0.007). This decreased in usage correlated to a cost savings of approximately $2000/patient. Despite no significant difference in the severity of the envenomations between the two groups (p=0.379), the treatment group experienced a significantly shorter hospital length of stay (1.933 vs 2.791 days, p=0.030). No significant difference in the progression to fasciotomy or the development of allergic reactions was noted between the two groups.
  
  
  CONCLUSIONS
  Use of a clinical protocol related to snake envenomations resulted in approximately two fewer vials of FabAV required for each patient. In addition, the treatment group experienced a shorter hospital length of stay without a corresponding increase in adverse events or envenomation progression. Data show that use of the protocol was cost-effective. The development of institution-specific multidisciplinary protocols regarding snake bite envenomations is recommended. Clinical pharmacists can play a vital role in the protocol development to ensure that optimal care is provided for this distinct patient population.
authors.affiliation: Department of Pharmacy Services, University of Kentucky HealthCare, Lexington, Kentucky 40536-0293, USA. kaw9600@alumni.unc.edu
authors.forename: Kyle A
authors.initials: KA
authors.lastname: Weant
authors.forename: Rebecca C
authors.initials: RC
authors.lastname: Bowers
authors.forename: Janelle
authors.initials: J
authors.lastname: Reed
authors.forename: Kristopher A
authors.initials: KA
authors.lastname: Braun
authors.forename: David M
authors.initials: DM
authors.lastname: Dodd
authors.forename: Stephanie N
authors.initials: SN
authors.lastname: Baker
mesh_terms: D000046:Academic Medical Centers; D000328:Adult; D000465:Algorithms; D000997:Antivenins / Q000008:administration & dosage / Q000009:adverse effects / Q000191:economics* / Q000627:therapeutic use*; D002985:Clinical Protocols / Q000592:standards*; D003362:Cost-Benefit Analysis; D017723:Drug Utilization Review; D005260:Female; D006801:Humans; D007140:Immunoglobulin Fab Fragments; D007128:Immunoglobulin Fragments / Q000008:administration & dosage / Q000009:adverse effects / Q000191:economics* / Q000627:therapeutic use*; D007629:Kentucky; D008297:Male; D012189:Retrospective Studies; D012720:Severity of Illness Index; D012909:Snake Bites / Q000188:drug therapy* / Q000191:economics; D016896:Treatment Outcome
chemical_list: D000997:Antivenins; C431183:Crotalidae Polyvalent immune Fab; D007140:Immunoglobulin Fab Fragments; D007128:Immunoglobulin Fragments