Conformité des établissements de santé du Québec aux recommandations de stockage des antidotes

Resume Objectifs : L’objectif principal consiste a presenter la conformite des etablissements de sante quebecois trois ans apres la publication des recommandations de stockage d’antidotes etablies par le Centre antipoison du Quebec. Les objectifs secondaires visent a decrire les facteurs de non-conformite et a emettre des recommandations afin d’ameliorer la gestion des antidotes au Quebec. Methodologie : Il s’agit d’une etude descriptive transversale realisee a l’aide d’un sondage electronique structure. L’enquete cible les 121 etablissements de sante du Quebec fournissant des services d’urgence et porte sur le stockage de 38 antidotes entre janvier et avril 2012. Resultats : Soixante-dix-huit (78) des 121 etablissements vises par l’enquete ont repondu au sondage. Les repondants representent 16 des 18 regions sociosanitaires. Soixante-et-un pour cent (61 %) (23/38) des antidotes etudies sont entreposes selon les recommandations emises par le Centre antipoison du Quebec. Les 15 antidotes dont les reserves se situent sous le minimum recommande sont : l’anticorps specifique de la digoxine, le chlorure de calcium, le dimercaprol, l’EDTA dicalcique, l’ethanol injectable, le fomepizole, le glucagon, l’hydroxocobalamine, la levocarnitine, la physostigmine, la pralidoxime, la pyridoxine, le succimer, le thiosulfate de sodium, les trousses contre le cyanure. Conclusion : Cette etude descriptive met en evidence la non-conformite des etablissements de sante aux recommandations du Centre antipoison du Quebec portant sur le stockage des antidotes meconnus, couteux, moins frequemment utilises ou non commercialises au Canada. L’implantation d’un registre provincial des antidotes pourrait aider a pallier certaines lacunes et ainsi ameliorer la qualite des soins prodigues aux patients se presentant avec une intoxication grave ou potentiellement letale. Abstract Objectives: The main objective of this article is to discuss compliance of Quebec healthcare institutions with recommendations regarding antidote stocking, three years after they were published by the Quebec Poison Control Center. Secondary objectives included a description of factors that contributed to non-compliance and to provide recommendations to improve the management of antidotes in Quebec. Methods: This is a descriptive cross-sectional study using a structured electronic survey. It targeted the 121 healthcare establishments in Quebec that provide emergency care and dealt with storage of 38 antidotes from January to April 2012. Results: Seventy-eight of the 121 hospitals responded to the survey. Responders represented 16 of the 18 health regions. Sixty-one percent (23/38) of the antidotes were stored according to the recommendations of the Poison control center of Quebec. The following 15 antidotes were stocked below recommended values: digoxin-specific antibody fragments, calcium chloride, dimecaprol, calcium disodium EDTA, injectable ethanol, fomepizole, glucagon, hydroxocobalamin, levocarnitine, physostigmine, pralidoxime, pyridoxine, succimer, sodium thiosulfate, and cyanide antidote kits. Conclusion: This descriptive study highlights the non-compliance of healthcare institutions with recommendations from the Quebec Poison Control Center. The implementation of a provincial registry for antidotes would help manage deficiencies and improve the quality of care provided to patients presenting with a serious or potentially lethal intoxication. Key words: Antidote, compliance, institution, stocking, toxicology