Many surgical facilities are having trouble securing anesthesia and pain medications due to widespread drug shortages. Making matters worse is having to waste large amounts of these scarce drugs that are left over in single-dose vials. As you know, you can't use the medications on more than 1 patient. Here's a summary of the advice readers shared on Outpatient Surgery Magazine's Second Opinions Discussion Board.
Split larger single-dose vials into smaller doses. If alternative medications aren't more readily available, have a licensed pharmacist split larger single-dose vials into smaller doses that eliminate leftovers. Eldon Armstrong, RPh, FIACP, a pharmaceutical consultant and past member of the United States Pharmacopeia, suggests you partner with a credentialed sterile compounding pharmacy. "The prices vary, so get a quote from 2 or more options" before committing, he advises. Compounding pharmacies can make up more manageable 1ml syringes of anesthetics such as fentanyl, says Cherie Shevlin, RN, the director of surgical services and nursing at EyeHealth Eastside Surgery Center in Clackamas, Ore. "It's a little more expensive, but not outrageous," she notes. "It works well and is stable for several weeks."
Use IV acetaminophen instead of narcotics. The anesthesiologists at the Plastic Surgery Associates of Orange County Calif., now use IV acetaminophen instead of narcotics to control patients' post-op discomfort. Ellen Wilson, the practice's OR manager, admits, however, that the drug is a pricey alternative. "Other than closely monitoring the drugs we use, who we use them on and staying on top of supplies by placing orders sooner rather than later, I don't know what else we can do," she says. "The shortages are crazy."
According to an abstract presented at this year's annual meeting of the American Society of Anesthesiologists, administrators at Duke University Medical Center in Durham, N.C., formed a Drug Shortage Response Team when dwindling supplies of succinylcholine threatened the safety of the facility's surgical patients. The DSRT required that Duke's OR pharmacy manage the succinylcholine supply, stopped the prophylactic preparation of the drug, mandated the use of multidose vials and limited stocking of the drug to only 1 vial per anesthesia cart. The measures reduced daily vial use from 50 to 20 and extended the medical center's succinylcholine supply from 12 to 21 days.
Daniel Cook
