Combined evidence-based literature analysis and consensus guidelines for stocking of emergency antidotes in the United States

被引:77
作者
Dart, RC
Goldfrank, LR
Chyka, PA
Lotzer, D
Woolf, AD
McNally, J
Snodgrass, WR
Olson, KR
Scharman, E
Geller, RJ
Spyker, D
Kraft, M
Lipsy, M
机构
[1] Univ Colorado, Hlth Sci Ctr, Dept Surg,Rocky Mt Poison & Drug Ctr, Denver Hlth & Hosp Author, Denver, CO 80230 USA
[2] NYU, Bellevue Hosp Ctr, Sch Med, Med Ctr,Dept Emergency Med, New York, NY 10016 USA
[3] Univ Tennessee, Dept Pharm, So Poison Ctr, Memphis, TN 38104 USA
[4] Univ Wisconsin Hosp, Poison Ctr, Madison, WI 53792 USA
[5] Harvard Univ, Childrens Hosp, Sch Med,Dept Pediat,Program Clin Toxicol, Massachusetts Rhode Isl Poison Control Ctr,Dept M, Boston, MA 02115 USA
[6] Univ Arizona, Arizone Poison & Drug Informat Ctr, Tucson, AZ USA
[7] Univ Texas, Med Branch, Dept Pediat, SE Texas Poison Ctr, Galveston, TX 77550 USA
[8] Calif Poison Control Syst, San Francisco Div, San Francisco, CA USA
[9] W Virginia Poison Ctr, Charleston, WV USA
[10] Emory Univ, Sch Med, Dept Pediat, Georgia Poison Ctr, Atlanta, GA USA
[11] US FDA, Ctr Devices & Radiol Hlth, Div Cardiovasc & Resp Devices, Washington, DC 20204 USA
[12] Univ Colorado, Hlth Sci Ctr, Natl Jewish Med & Res Ctr, Div Pulm & Crit Care Med, Denver, CO USA
[13] Univ Arizona, Intergrp Arizona, Tucson, AZ USA
关键词
D O I
10.1067/mem.2000.108182
中图分类号
R4 [临床医学];
学科分类号
1002 ; 100602 ;
摘要
Study objective: To develop guidelines for the stocking of antidotes at hospitals that accept emergency admissions using combined evidence-based and consensus methods. Methods: Study participants were 12 medical care providers from disciplines that are affected by insufficient stocking of emergency antidotes (clinical pharmacology, critical care, clinical pharmacy, emergency medicine, hospital pharmacy, internal medicine, managed care pharmacy, clinical toxicology, pediatrics, poison control centers, pulmonary medicine, regulatory medicine). Selection of individuals for the study panel was based on evidence of previous antidote research or perspective regarding the purchase and use of antidotes. The literature regarding each antidote was systematically amassed using pre-1966 literature files, current MEDLINE searches, the reference lists of major medical textbooks, and citations solicited from the consensus panel. Articles relevant to 4 defined core questions were included. These articles formed the basis of an evidence-based analysis performed by the principal investigator. After literature analysis, a literature summary and proposed guidelines for antidote stocking were submitted to the panel. Consensus was formed by electronic iterative presentation of alternatives to each panel member using a modified Delphi method. All panel members participated in 5 rounds of guideline analysis of 20 antidotes. Results: Of the 20 antidotes, 16 antidotes were ultimately recommended for stocking (N-acetylcysteine, atropine, Crotalid snake antivenin, calcium gluconate and chloride, cyanide antidote kit, deferoxamine, digoxin immune Fab, dimercaprol, ethanol, fomepizole, glucagon, methylene blue, naloxone, pralidoxime, physostigmine, sodium bicarbonate), 2 were not recommended for stocking (black widow antivenin, ethylenediamine tetraacetic acid), and consensus could not be reached for 2 antidotes (flumazenil, physostigmine). Conclusion: These guidelines provide a tool to be used in revising or creating policies and procedures with regard to the stocking of antidotes in hospitals that accept emergency patients.
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收藏
页码:126 / 132
页数:7
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