*Izaak Walton Killam Regional Poison Centre,Halifax,NS.
‡Pharmacy Department,Nova Scotia Health Authority,Halifax, NS.
CJEM. 2019 Jan;21(1):37-46. doi: 10.1017/cem.2017.400. Epub 2017 Sep 20.
Inadequate stocking of essential antidotes in hospitals is an internationally documented problem. A concrete and sustainable system-wide solution for easy access to antidotes in emergency departments (EDs) was developed and implemented in Nova Scotia, Canada.
Antidote stocking guidelines and a systemwide antidote management strategy were established. A standardized collection of antidotes housed in highly visible containers in provincial EDs was implemented for timely access. Antidote-specific online administration guidelines were developed. Using the poison centre for surveillance, the antidote program maintained a database of antidote utilization patterns; 11 years of data were available for analysis.
2/2 (100%) tertiary care, 9/9 (100%) regional EDs, and 21/25 (84%) community EDs in Nova Scotia stock antidote kits, for an overall compliance rate of 32/36 (89%). A total of 678 antidotes (excluding N-acetylcysteine) were used for 520 patients. The distribution of antidote use by hospital type was 99/678 (14.6%) at community hospitals, 379/678 (55.9%) at regional hospitals, and 200/678 (29.5%) at tertiary care hospitals. The five most commonly used antidotes were: naloxone 143/678 (21.1%), fomepizole 111/678 (16.4%), glucagon 94/678 (13.9%), calcium 70/678 (10.3%), and sodium bicarbonate 67/678 (9.9%). Of the 520 patients in whom antidotes were used, death occurred in 3% (15/520), major outcomes in 35% (183/520), and moderate outcomes in 39% (205/520).
The Nova Scotia Antidote Program demonstrates that a solution to inadequate antidote stocking is achievable and requires a system-wide approach with ongoing maintenance and surveillance. The frequency and distribution of antidote usage documented in this program supports the need for enhancement of emergency preparedness. The poison centre and hospital pharmacies are crucial to surveillance and maintenance of this program.
医院基本解毒剂储备不足是一个在国际上有记录的问题。加拿大新斯科舍省开发并实施了一种具体且可持续的全系统解决方案，以便在急诊部（ED）方便获取解毒剂。
制定了解毒剂储备指南和全系统解毒剂管理策略。在省级 ED 中，使用高度可见的容器集中存放解毒剂，以实现及时获取。制定了解毒剂专用在线管理指南。利用中毒控制中心进行监测，解毒剂计划维护解毒剂使用模式数据库；可分析 11 年的数据。
新斯科舍省的 2/2（100%）三级保健、9/9（100%）地区 ED 和 21/25（84%）社区 ED 储备解毒剂套件，总体合规率为 32/36（89%）。520 名患者共使用了 678 种（不包括 N-乙酰半胱氨酸）解毒剂。按医院类型分布的解毒剂使用情况为：社区医院 99/678（14.6%），地区医院 379/678（55.9%），三级保健医院 200/678（29.5%）。使用最多的五种解毒剂是：纳洛酮 143/678（21.1%）、非那唑醇 111/678（16.4%）、胰高血糖素 94/678（13.9%）、钙 70/678（10.3%）和碳酸氢钠 67/678（9.9%）。在使用解毒剂的 520 名患者中，3%（15/520）死亡，35%（183/520）出现主要结局，39%（205/520）出现中度结局。
新斯科舍省解毒剂计划表明，解决解毒剂储备不足的问题是可行的，需要采取全系统方法，并持续维护和监测。该计划记录的解毒剂使用频率和分布支持加强应急准备的必要性。中毒控制中心和医院药房对该计划的监测和维护至关重要。
