May 17, 2019 – One of the most striking realizations about the Food and Drug Administration (FDA) drug shortage list is how many of the medications are life-saving. For example, what would a clinical team do if there was no atropine available in the emergency room when a patient’s heart rate is dangerously slow? Or no sodium bicarbonate to administer when a patient is in cardiac arrest? Imagining that is very unsettling.
Unfortunately, atropine and sodium bicarbonate are just two of hundreds of commonly used medications on the FDA shortage list. Without these drugs that are part of standard response protocols in critical situations, patient safety is in jeopardy.
In this blog post, we’ll explore a few scenarios pointing to major safety risks and what hospitals are doing to keep their patients safe.
- Protect limited supply for critical patients
Low potassium can be life-threatening in certain situations. It is also common in hospitalized patients for multiple reasons including diarrhea, diuretics and poor nutrition. As a result, the potassium replacement protocol is a common element of hospital admission order sets. Yet the vast majority of those instances can be handled with oral potassium or simply by correcting the underlying problem. Many patients object to taking the liquid form because it tastes bad, so the IV form gets overused. In many other cases, potassium is simply over-replaced and correcting the underlying etiology is sufficient. With injectable potassium currently in short supply, hospital pharmacists must address these cases of over-use to reserve the hospital’s IV potassium for critical situations.
- Support accurate dosing adjustments
The FDA shortage list includes many medications that have available substitutions, including beta blockers like bisoprolol and IV diuretics such as bumetanide. The challenge is that switching from one medication to another can involve complicated dosage conversions. Pharmacists also must provide support to the physicians who are ordering and the nursing teams who are administering the alternative medication to ensure the right dose is delivered. Replacement options for certain drugs, such as diltiazem ― another drug on the shortage list ― can be complicated to administer. Changing to a different medication often requires switching pumps and ensuring they are set up properly to deliver the right concentration and frequency. These changes are time consuming. Switching to a replacement medication that is unfamiliar to clinical staff can result in errors that put patients at risk.
- Understand patient populations and prescribing patterns
Another drug on the FDA shortage list is the IV form of labetalol, which provides fast-acting blood pressure control. It’s commonly used in the operating room, by anesthesia teams, and in obstetrics, for pre-eclampsia patients and other cases where it’s necessary to get blood pressure down immediately. If labetalol is being used across the hospital in cases where it’s not necessary to get blood pressure down right away, there may not be enough of it in critical situations. Knowing when and where to allow use of limited supplies of a drug like labetalol involves complex clinical decisions. To make those choices, pharmacists must understand patient populations, prescribing patterns and which hospital order sets can be modified to manage demand. Pharmacists need visibility into prescribing habits so they can intervene to preserve life-saving drugs for the most critical situations.
- Implement temporary guidelines and usage restrictions
To protect limited supplies of medications that tend to get overused, hospitals need a toolkit for managing demand with varying degrees of severity. A more subtle change could be removing drugs from common order sets. More restrictive steps might be limiting use to a few specialty areas or populations. The most extreme controls might include only placing critical medications on crash carts and in the operating room.
- Prevent and manage shortages
Protecting limited supplies of life-saving medications is easier to do when you have the right information at your fingertips. Thankfully, there is a solution that helps hospitals mitigate the impact of shortages and manage them more efficiently when they can’t be avoided: The Drug Shortage App from LogicStream Health™.
The Drug Shortage App helps hospitals better manage drug shortages and minimize disruptions to patient care by providing pharmacy teams visibility into ordering, prescribing and dispensing practices so they can take control of medications in short supply. Learn more about what this solution can do to help your organization by downloading an overview of The Drug Shortage App at www.thedrugshortageapp.com.
Brita Hansen, M.D., is Chief Medical Officer of LogicStream Health. She began her career as an internal medicine hospitalist physician after receiving her undergraduate degree at NYU and her Doctorate of Medicine from the University of Minnesota School of Medicine. She served as Chief Health Information Officer for the Hennepin County Medical Center before joining LogicStream Health.