Emergency drug availability on general paediatric units.

Abstract

Following an incident where intravenous lorazepam was not available on a general paediatric ward we undertook a national survey of emergency drug availability on general paediatric units in the United Kingdom. Drugs chosen were those recommended in the Advanced Paediatric Life Support manual and the British National Formulary for the management of the most common paediatric emergencies. Twelve drugs were chosen covering emergencies in the following systems: cardiovascular (adrenaline (epinephrine), atropine and adenosine); neurological (flumazenil, lorazepam, paraldehyde, phenytoin and mannitol); metabolic (Hypostop Gel and glucagon); analgesia related (naloxone); and respiratory (aminophylline). A thirteenth drug, intravenous salbutamol was included in a reminder letter sent to non-responding units. Questionnaires were sent to 274 units. Replies were received from 242 (88.3%), of whom 20 did not have a general paediatric ward, leaving 222 units (81.0%). Drug availability varied for the different drugs: adrenaline (available on 100% of units), atropine (98.2%), naloxone (96.4%), phenytoin (95.9%), aminophylline (93.2%), paraldehyde (92.3%), mannitol (87.8%), lorazepam (86.9%), glucagon (86.5%), Hypostop Gel (80.6%), adenosine (72.1%) and flumazenil (66.7%). Six of the drugs were classified as first line agents (adrenaline, atropine, adenosine, lorazepam, paraldehyde and aminophylline). Over one in 10 units did not stock two or more of these first line drugs. Consideration needs to be given to the compiling of a consensus based list of drugs that ought to be stocked on all general paediatric units.