5 Proactive Measures for Anesthesiologists to Combat Drug Shortages

Drug shortages have unfortunately become a routine occurrence in operating rooms in the past few years. The number of drug shortages tripled from 2005-2010, according to the FDA. Last year, 211 drug shortages were reported, and as of October this year that number had risen to 213. Drug shortages can affect surgical outcomes and patient safety, but good management of a shortage can mitigate negative effects.

In last month's issue of Anesthesia & Analgesia, Gildasio S. De Oliveira Jr., MD, Luke S. Theilken, MD, and Robert J. McCarthy, PharmD, urged anesthesiologists to take an active role to prevent adverse effects. Dr. Theilken, an anesthesiologist at Northwestern Memorial Hospital, outlines five ways anesthesiologists can do just that.

1. Waste not, want not. Dr. Theilken says being aware of exactly which and how much medication an anesthesiologist is using can go a long way.

"One of the very basic ways an anesthesiologist can help out with any kind of shortage is to be very thoughtful of the use and indications of the medication that they have available to them," Dr. Theilken says.

He says to be careful when opening a new vial of a medication and to make sure the medication is actually warranted. For example, many physicians give Zofran, a drug used to prevent nausea and vomiting caused by cancer chemotherapy, radiation therapy and surgery, when there's no patient history of vomiting. Watching out for things like this can curb unnecessary medication use.

2. Keep an eye on supply and watch for shortages. Dr. Theilken recommends that the anesthesia group nominate one person to be in constant contact with the pharmacy or the administrator of the surgery center or hospital. This person can keep track of supplies and will be able to spot a shortage before it happens. This way, a plan can be put in place to deal with the shortage and help alleviate both the severity and length of the shortage. Dr. Theilken also says anesthesiologists should be familiar with the protocol developed by the American Society of Health-System Pharmacists for dealing with drug shortages. http://www.ashp.org/shortages

3. Allocate medication to the right people. Dr. Theilken also recommends making sure scarce drugs are allocated to the divisions and areas where they're most needed. For example, a nurse performing conscious sedation might be familiar with using Fentanyl for that procedure but not with using morphine, dilaudid or meperidine. If a limited supply of Fentanyl is available, it should be allocated to the person who is least comfortable using an alternative. Often, anesthesiologists are more comfortable using a wider range of medications, so if a shortage arises, they should use the alternative when possible.

"As anesthesiologists, we're all very familiar with the side effects and ramifications of these medications," Dr. Theilken says. "If there has to be a change made, then we have to allocate the medications to where they're most known. Make sure that it's going to the safest hands."

4. Ask the pharmacy to create small, sterile doses. Dr. Theilken says that a lot of the medication used by anesthesiologists comes in unit-based packaging. Because a container can only be used for one procedure, this leads to waste. For example, Propofol often comes in 200 milligram vials, so if a physician only needs to use 100 milligrams, the rest goes to waste.

The pharmacy can create smaller vials in a sterile manner. Dr. Theilken says the pharmacy can also create different concentrations of medications. For example, if anesthesiologists want to use Phenylephrine, they have to mix up an entire bag, but might only use a small fraction of that. The pharmacy can create a different concentration so the rest of the medication doesn't go to waste. Another example is Decadron, which generally comes in a 5cc, 4mg/cc bottle. Anesthesiologists often only need to use 1 or 2 ccs, depending on the concentration. Without splitting it up, 80 percent of that bottle goes to waste.

5. Educate the rest of the staff. Arranging for medication to be split into smaller doses and allocating drugs to certain departments is great, but it won't help unless the staff understands the changes, Dr. Theilken says.

"Anesthesiologists need to take an active role in educating people, other physicians and care providers that there has been a change," he says.

This can be as simple as posting the changes to the pharmacy wall, sending out an email or mentioning the changes at a staff meeting.

"There really needs to be a multi-modal approach for educating people and making sure the word is out," he says.

Related Articles on Drug Shortages:
Drug Shortages Worst in Oncology, Emergency Medicine, Anesthesia and Cardiology
Drug Shortages Force Cleveland Hospitals to Stock Up for Future
Commentary: Anesthesiologists Should Take Active Role in Drug Safety, Shortages

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