Increasing short supplies involving some of the most critical medicines are not only causing frustrations for physicians and other health professionals but are affecting patient care.
According to a national study by the Institute for Safe Medication Practices (ISMP) drugs, such as propofol, heparin, morphine, neuromuscular blocking agents and chemotherapy agents, are most likely to be in short supply. They are also medications that could cause serious patient harm when involved in an error.
“This is the worst I’ve seen in 31 years of practice,” said Jim Jorgenson, R.P.H., M.S., executive director of Pharmacy Services for Indiana University Health. “Some days, we have to decide who of the most critical patients will receive a drug that’s in short supply.”
Tipton anesthesiologist Melanie Rookstool, M.D., has experienced a shortage of propofol. “I have had to use an alternative method,” she explained. “It compromises our ability to provide quality care and it can increase costs.”
Indiana Board of Pharmacy member Donna S. Wall, PharmD., R.Ph., said several factors affect drug shortages. She noted two problems included the unavailability of raw ingredients to make drugs and strict Food and Drug Administration (FDA) enforcement actions that shut down noncompliant companies, especially those who make generics. She also said that hoarding is an issue with some major pharmacies.
What you can do
About four health care groups are creating a list of recommendations for the FDA and the pharmaceutical industry to help reduce the occurrence of drug shortages and better manage them when they occur.
For physicians, Wall offers these suggestions on coping with drug shortages:
- Check websites for shortages; find a current list on the ASHP website.
- If a drug is in short supply, prescribe judiciously.
- Collaborate with others to get the drugs to most appropriate patient.
Terre Haute oncologist Chandra Reddy, M.D., advised, "If I foresee the shortage of a particular drug is only for a short period and no replaceable drugs are available that are equal in efficacy and tolerance, I reschedule the patient after a well-informed discussion. If I anticipate trouble getting that drug in more than two to three weeks, I find an alternative regimen or replace another appropriate drug. It takes extra time and effort to work around it."
Read details of the ISMP study here.