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Basic Emergency Department Medications in Short Supply

Experts blame ‘manufacturing challenges’

Emergency physicians are devising workarounds for shortages of intravenous (IV) solution and at least one life-saving drug because suppliers can’t meet the demand — partly because of manufacturing problems, according to an article posted on the HealthLeaders Media website.

In addition to saline and IV solution shortages over the last year, basic supplies, such as epinephrine, dextrose-filled syringes, and nitroglycerin injections, have also been scarce, the article says.

“Sometimes, not even second-choice drugs have been available,” said William Jaquis, MD, chief of the department of emergency medicine at LifeBridge Health in Baltimore, Maryland. Jaquis said his team is often forced to figure out a substitute “on the fly,” and then try to find supplies and calculate the correct dose.

“It delays the patient’s treatment, and in the emergency room, minutes have impact. Those few minutes in these situations can be crucial,” he said.

Curtis Rooney, president of the Healthcare Supply Chain Association, noted that the number of medical product shortages has increased. Serious quality issues slowed down production, he said, and that kept basic medical supplies, such as saline, out of stock last year.

“There have been manufacturing challenges,” he explained. “Upon inspection of IV bags, particles and sometimes fungus or glass were found by inspectors.” Rooney added that similar quality problems have occurred in the manufacturing of epinephrine and dextrose.

His advice to hospitals is to attempt to work with their suppliers to see whether they can obtain more of the supplies that they might be low on. “I would call your [group purchasing organization]. If that doesn't work, you can try calling another local hospital [and] ask if they have anything to spare. Also, try wholesale distributors,” he advised.

Bona Benjamin, director of medication-use quality improvement at the Center on Medication Safety and Quality at the American Society of Health-System Pharmacists, was relieved when the FDA allowed saline from Europe to be imported to the U.S. last year, but she and the other leaders at her hospital felt the sticker shock. “The price went way up — it was five, maybe six times what we were accustomed to paying per bag. But at least we had some access to it,” she said.

Jaquis is also concerned about the cost to his hospital and the availability of these supplies. “There’s generally a secondary market for these commonly used medications,” he said. “It’s a more competitive market than when you go through normal channels. It’s like going to a ticket dealer the night before Ohio State plays Michigan for a Big Ten Championship. They have a limited supply of these basic materials, and your buyer is competing with a bunch of other people to get the same medications.”

Rooney hopes the FDA will consider approving more manufacturers in the near future, but he says it will be a long time before emergency department staff can breathe a sigh of relief.

Source: HealthLeaders Media; June 12, 2015.

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