Stocking emergency medications: Research first
Stocking emergency medications: Research first
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Stocking antidotes and other rarely-used emergency medications is almost an afterthought at many hospitals.
"A lot of these are drugs that are used to treat relatively uncommon conditions," says Nancy S. Jordan, PharmD, BCPS, pharmacy clinical coordinator at Albuquerque, NM-based Presbyterian Healthcare Services and Espanola Hospital's department of pharmacy in Espanola, NM.
"It takes a certain effort for hospitals to wrap their hands around this issue," Jordan adds.
Leaders at Presbyterian Healthcare Services, which is a multihospital system that includes both large and small hospitals, decided to improve procedures for stocking antidotes and other emergency medications, she says.
"There are a lot of emergency conditions where patients need medications to treat them, and the typical ones are antidotes," Jordan explains. "We looked at the patients coming into the emergency room with poisoning and wanted to see if the pharmacy had the drugs we needed in the right quantities."
The first step was to update the antidote list. Jordan first researched the topic of antidotes and emergency medications, and then she compared what she found in the literature with what the hospital system already stocked for emergencies.
"We looked at our antidote list and decided there are additional medications we should have that weren't on the list," Jordan says.
For instance, it's rare for a hospital to see a case of cyanide poisoning, yet hospitals still need to stock a recommended antidote to this potential emergency because a case of cyanide poisoning is fatal if not treated quickly, she explains.
The next step was to update the antidote list's quantities.
"We translated the recommended quantities into something more user-friendly," Jordan says.
For example, the literature suggests quantities in grams, but not all of the necessary drugs are packaged in gram quantities or they might be packaged in liquid form, Jordan says.
The idea was to provide a guide that would quickly show clinicians how many vials they would need of a particular medication.
"We worked as a system to get some cohesion and agreement so we would all carry the same quantities and products," Jordan says.
The hospital's antidote list has more than 20 items.
"A typical example of an antidote medication on the list and which we're stocking is oral acetylcysteine, a medication used to treat Tylenol® overdoses," Jordan says. "Another one we've added and classified as an emergency medication is IV dantrolene, which is used to treat malignant hypothermia."
Malignant hypothermia is a dangerous condition precipitated by use of neuromuscular blockers, she explains.
"Anti-venom for treating snake bites is also on our emergency list," Jordan says. "We had a lot of discussion within our organization as to whether we should change the nationally recommended quantities and stock more of this, and we decided to stock more."
This is something every pharmacy director should consider: Which types of poisonings are more common in your region, Jordan suggests.
"What do you need to stock and how much is practical for you?" she says.
Stocking these drugs can be costly, she notes.
"When we constructed the original list it looked like it would cost around $40,000, not inconsequential, especially for a small facility," Jordan says. "Some of the big ticket items are now available generically, so the price may have come down."
But the reality is that some of the drugs are expensive and hospitals would need to keep a large quantity of them for conditions they hope to never see, she adds.
Also, hospital pharmacy directors could check with other local hospitals to see how easy it would be to borrow a certain medication if the hospital were to run out of one.
"Do we need XYZ amount of something, or can we stock enough to get the patient started and then borrow from a colleague down the street?" Jordan says. "We decided not to count on borrowing anything because with some medications there's not enough time to borrow."
Reach a consensus on what and how much to stock, she adds.
"We agreed on stocking quantities and prepared charts that directors of pharmacies took to their pharmacy and therapeutic committees for approval," Jordan says. "The pharmacists said, 'Here's our recommendations as to what products to have in stock to adequately treat emergencies that come through our door.'"
The next issue was deciding where to stock the products.
"The main hospital in Albuquerque has 24/7 pharmacy services," Jordan says. "So where do you stock something that isn't so critical in an organization like that?"
The smaller facilities have pharmacists on call at night, so where would they keep cyanide antidote kits, for example, which need to be available quickly if needed but might not be best suited for automatic dispensing cabinets, Jordan adds.
"You can have all the right products in stock, but if they're locked up then that's not very helpful," she says.
"The other thing we tried to do with a standardized list is to encourage facilities to come up with a designation on a chart as to where the products were physically located," Jordan says. "This way the nursing supervisor at night could quickly look at the list and see where the cyanide kits were."
Once a hospital pharmacy has established an emergency medication list and made changes to which medications and quantities would be kept in stock, it's important to monitor these changes on a regular basis.
For example, someone will need to check these uncommonly used medications periodically to see if they've expired and need to be replaced, Jordan suggests.
"Often in smaller facilities, it's easy to lose track of these sorts of things," she adds.
Stocking antidotes and other rarely-used emergency medications is almost an afterthought at many hospitals.Subscribe Now for Access
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