Availability of antidotes at acute care hospitals in Ontario

Background: Acutely poisoned patients sometimes require immediate treatment with an antidote, and delays in treatment can be fatal. We sought to deter mine 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% o f the hospitals stocked an adequate supply of digoxin immune Fab antibody f ragments, 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 sur vey. Only 1 hospital stocked adequate amounts of all 10 antidotes. Certain hospital characteristics were associated with adequate antidote stocking (i ncreased annual emergency department volume, reaching hospital status and d esignation as a trauma centre). Conversely, antidote supplies were particul arly deficient at small hospitals and, paradoxically, geographically isolat ed facilities (those most reliant on their own inventory). The cost of anti dotes correlated only weakly with stocking rates, and many examples of exce ssive antidote stocking were identified. Interpretation: Most acute care hospitals in Ontario do not stock even mini mally adequate amounts of several emergency antidotes, possibly jeopardizin g the survival of an acutely poisoned patient. Much of this problem could b e rectified at no additional cost by reducing excessive stock of expensive antidotes and redistributing the resources to acquire deficient antidotes.