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2SPD-017 Risk identification in antidote and emergency preparedness
  1. P Gambin,
  2. M Attard Pizzuto,
  3. A Anastasi
  1. Faculty of Medicine and Surgery, University of Malta, Department of Pharmacy, Msida, Malta


Background and Importance Globally, antidote preparedness has been identified as a major challenge (Antoniello et al, 2023). The healthcare system must be able to ensure antidote availability and effective management for both individual poison cases and for mass casualties, whilst weighing in the financial burden. This study recognised a gap in literature on the local situation of emergency preparedness with regards to antidotes and the risks in local antidote availability and accessibility. Identification of risks is crucial for the development of risk management strategies to ensure no disruptions in the antidote supply chain.

Aim and Objectives The aim of this study was to identify risks in the availability and accessibility of antidotes in a small nation.

Material and Methods Vertical audits of eight antidotes (pralidoxime, atropine sulphate 600 mcg/ml injections, hydroxocobalamin kit, sodium thiosulphate, sodium nitrite, digoxin immune fab, activated charcoal and, acetylcysteine) were performed at the procurement unit and two acute general hospitals, to identify risks starting from the sourcing to the dispensing of antidotes for patient use. A clinical expert focus group was established for validation and prioritisation of identified risks.

Results Five of the antidotes were noted to have problematic sourcing due to restricted availability on the open market. Logistics and costs of antidotes had a major influence on antidote availability and accessibility. Other identified risks include inadequate stocking of antidotes, lack of periodic review of procurement specifications, delay of antidote release from quarantine due to regulatory barriers, insufficient training, lack of guidelines and national contingency plan, unreliable suppliers and bureaucratic procurement processes.

Conclusion and Relevance This is the first study of this nature to take place in this small nation. Findings indicate critical need for healthcare system optimisation in emergency preparedness. Risks associated with availability can be mitigated through the establishment of international cooperation agreements at European and global levels. The risks identified will be utilised in the development of guidelines and recommendations on the optimisation of emergency preparedness based on risk management principles.

References and/or Acknowledgements 1. Antoniello AA, Pauls P, Awad NI, Sobolewski K, Fernandez D, Bridgeman P. Optimization of antidote stocking, availability, and administration practices for a large multihospital organization. American Journal of Health System Pharmacy. 2023;80(1):S1-S10. doi:10.1093/ajhp/zxac191.

Conflict of Interest No conflict of interest.

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