Drug shortages currently stand at over 100 different medications with the Food and Drug Administration (FDA) noting 111 products as being unavailable.

Some of these shortages are short term or limited availability, while others are completely unavailable with unknown release dates. What medications are unavailable and what can you do to minimize the impacts on your practice and patients?

The drug shortage problem is not new, nor is it a transitory issue. This week we are once again providing an update on the most recent drug shortages and giving you some steps to take to minimize the disruptions caused by them. Admittedly, there is no silver bullet for resolving medication shortages and each one requires individual attention.

Common ASC medications in short supply:

Atropine Sulfate Injection
Bacteriostatic Water for Injection
Bupivacaine Hydrochloride and Epinephrine Injection
Bupivacaine Hydrochloride Injection
Cefazolin Injection
Cyclopentolate Ophthalmic Solution
Dexamethasone Sodium Phosphate Injection
Dexmedetomidine Injection
Diltiazem Hydrochloride Injection
Dobutamine Hydrochloride Injection
Dopamine Hydrochloride Injection
Epinephrine Injection, 0.1 mg/mL
Epinephrine Injection, Auto-Injector
Fentanyl Citrate Injection
Furosemide Injection
Gentamicin Sulfate Injection
Heparin Sodium and Sodium Chloride 0.9% Injection
Ketamine Injection
Ketorolac Tromethamine Injection
Lidocaine Hydrochloride (Xylocaine) Injection
Lidocaine Hydrochloride (Xylocaine) Injection with Epinephrine
Lipid Injection
Mannitol Injection
Mepivacaine Hydrochloride Injection
Midazolam Injection
Morphine Sulfate Injection
Ondansetron Hydrochloride Injection
Propofol Injectable Emulsion
Ropivacaine Hydrochloride Injection
Sodium Bicarbonate Injection
Sodium Chloride Injection USP, 0.9% Vials and Syringes
Sterile Water for Injection
Triamcinolone Acetonide Injectable Suspension
Triamcinolone Hexacetonide Injectable suspension
Vecuronium Bromide for Injection

Steps you can take:

The solution to each shortage is going to differ by the medication involved and the available alternatives. In a previous post titled “Ten Steps to Dealing with Drug Shortages”, I discussed ways to deal with shortages. Some of the common steps you can take include:

Considering formulary alternatives
Try ordering medications from more than one source
Order as early as possible
Try different options, such a smaller or larger vials
Borrow from another facility (this is risky and requires checking state laws)

Something you can do to immediately to minimize the impact going forward, is to closely monitor your inventory and make sure you always have enough on hand to withstand a temporary shortage. Don’t run your par levels so low that a temporary shortage causes complete panic. Do some advance planning.

Finally, “expired” meditations may be a potential solution. The FDA continuously updates their list of medications that have extended expiration dates. If you have one of these medications on hand, you will be able to extend the date and keep it longer. Check with your pharmacy consultant on how to extend the date. Also, make sure you are labeling “expired” medication appropriately and documenting all attempts to obtain in-date medications. Having expired medications on hand with no process or documentation is a sure way to earn a survey deficiency.

If you are currently struggling with a particular shortage, work with your pharmacy consultant to come up with creative ways to work around it. This requires planning and expertise. Some solutions may seem obvious and easy, but they could be dangerous to patient safety and often not compliant with licensing or accreditation standards. If you have questions about a current shortage, or how to set up a compliant system, don’t hesitate to reach out to us.

The Consultant Pharmacists at OctariusRx provide guidance on safe medication management, survey readiness and cost savings to ambulatory healthcare facilities/surgery centers, senior care facilities and pharmacies. We also help individual patients optimize their medications to improve their quality of life and save money. Contact us for assistance.