Managing Medication Shortages in the ASC

Written by: Gregory Tertes, President and Consultant Pharmacist of ASC Pharmacist Consultants, Inc.

You’ve probably heard in the news recently of medication shortages, and perhaps have even encountered such shortages when trying to order stock your own facility. Unfortunately, these shortages — which can be difficult to navigate — seem to be becoming a normal part of business.

In fact, in 2017, 146 medication shortages were reported, while in 2018, 186 shortages were reported — a 27 percent increase from the previous year, according to Alia Paavola with Becker’s Hospital Review, Jan. 18, 2019. To add to this already alarming rate, 55 percent of these shortages were injectable medications, meaning they have been particularly impactful on the surgery suite and its patients.

These shortages are a result of several interrelated forces, including:

  • Increased regulatory enforcement, causing manufacturing closures/delays and additional recalls;
  • Worldwide sourcing of raw materials, creating competition for specific substances and consequently, occasional shortages; and
  • Consolidation and elimination of product lines, decreasing the quantity of manufacturers that are making certain medications.

While these circumstances cannot be helped by you or your consultant pharmacist, the good news is that you can take action to prevent medication shortages from affecting your patients.

Take a Systematic Approach

Medication shortages present an ongoing risk to patient care. Therefore, it’s a matter of safety to have proactive strategies in place to handle these shortages. Follow the tips below to help your organization avoid common medication shortage pitfalls.

  • Stay informed. See current and past medication shortages by visiting the ASHP website.
  • Ensure you have more than one wholesaler supplier. While you can maintain one primary source, ensure you have several other credentialed sources to reach out to for difficult-to-find medications.
  • Maintain good relationships with local ambulatory surgery centers (ASCs). Chances are, if you are experiencing a shortage, another ASC may have the drug(s) you need. When working with other centers, be sure to follow the Drug Quality and Security Act (DQSA) and track recalls.
  • Look for clinical alternatives. For instance, look for Dextrose 50 percent vials when prefilled syringes are on backorder, or switch to famotidine when ranitidine is on backorder. When using alternatives, be sure to find out if additional syringes are necessary and communicate whether the alternative medications need to be refrigerated or can be placed in the anesthesia cart.
  • Keep diligent records. Have a form or spreadsheet where you list all medications currently on shortage along with those you have resolved. Not only will this help you keep track of shortages, but it will also come in handy with surveyors who may want to see such tracking.

Keep the Lines of Communication Open

During shortages, the chance of medication errors can increase and put patients at risk. For instance, many facilities stocked Atropine 1mg/ml vials when Atropine 0.4mg/ml 1ml vials went on shortage. Since the two vials look extremely similar, the chance of patients receiving more medication than planned increased. To prevent the likelihood of such errors, create and employ a clear, thorough communication process like the one outlined below.

  • Follow a process where clinical decisions are made by the medical or anesthesia director and then brought to the medical executive committee for validation;
  • Email anesthesia, surgeons, and appropriate team members afterwards so they are aware of any changes;
  • Have a white board or another site where shortage items and recommended substitutes can be posted and easily seen; and

Place notes at the location of use, like the medication shelf or the cubby in the anesthesia cart where medications are stocked.

Be Proactive

Hopefully, this provides a roadmap for your center to address medication shortages in a systematic manner that prevents patients from being affected. These proactive strategies can support you in having the necessary medications and communication methods in place to provide excellent care when facing shortages.

LEARN MORE: Gregory Tertes facilitated a webinar on the topic of Medication Shortages and How to Handle them on Monday, November 25th. Click to view the recording and download the slides.