Supplies of the sedative-hypnotic agent propofol are down about 25% nationwide after 2 manufacturers recalled several lots of the sedative last month, say industry observers, a complication which may be putting a pinch on surgical facilities.

As manufacturers work to address the shortage, medical facilities should resist the temptation to hoard the drug or break up single-use vials for use in multiple cases, say officials from the FDA, the American Society of Anesthesiologists and the American Society of Health-System Pharmacists, who held a conference call on the subject last week. (Let us know how the propofol shortage has affected you in Outpatient Surgery Magazine's InstaPoll.)

Both Teva Pharmaceuticals and Hospira recalled multiple lots of generic propofol in October due to unrelated problems: the discovery of potential microbial contamination in Teva's case, and of metal particles in certain lots of Hospira's product. According to the FDA, Hospira expects to release new propofol by mid-November, while Teva is scheduling December availability for its products.

APP, which manufactures propofol under the brand name Diprivan, has stepped up production to help ease the shortage, but is currently allocating supplies due to increased demand. A potential substitute drug - Penthothal, Hospira's sodium thiopental for injection - is also in short supply due to manufacturing issues. The company says it expects to resume production in January 2010. And some facilities have reported price gouging by drug wholesalers, a problem the FDA says it does not have the authority to address.

The FDA is working with manufacturers to increase the availability of propofol and may consider importing it from other countries, says an FDA official. In the meantime, facilities are advised "to continue ordering product at historic levels and to not engage in additional bulk ordering that could lead to diminished supply for others." Facilities which experience difficulties in obtaining adequate supplies of the drug are encouraged to e-mail the FDA's Drug Shortage Group.

Irene Tsikitas

Degrading comments and insults top the list of behavioral problems that physicians and nurses say affect staff morale, patient safety and public perception of the healthcare industry, according to a poll conducted by the American College of Physician Executives.

The 2,100 clinicians surveyed identified yelling, cursing, inappropriate joking and refusing to work with one another as common issues they face. Both groups accept blame for disruptive behavior in the workplace, but they agree that physicians are responsible for a larger percentage of the inappropriate conduct.

In the past year, 13% of those surveyed had witnessed acts of sexual harassment in the workplace. One respondent claimed that a male doctor told a female nurse's superiors that she'd performed her job poorly after the nurse refused to date him, according to a summary of the survey's results.

Nurses are not without fault, however, when it comes to improper workplace behavior. Survey respondents cited RNs for backbiting, spreading rumors and attempting to blackball doctors or other members of the staff.

Most survey respondents said physician-nurse relationships could be improved with increased education about appropriate workplace conduct. But only slightly more than half said their organizations had instituted programs aimed at improving such working relationships in the past year.

Daniel Cook

In the wake of Rhode Island Hospital's fifth wrong-site surgery since 2007, the state's department of health has fined it $150,000 and required the monitoring and recording of surgeries to ensure compliance with safety precautions and to train staff.

The Providence hospital, the state's largest, must equip each of its ORs with video cameras and record each surgeon performing a procedure at least twice a year (with patients' permission), a step that state officials describe as unprecedented in healthcare regulation. The hospital has also been ordered to place clinical employees who aren't participating in cases in each OR to observe all the hospital's surgeries for a year.

"You know what? They should be open to that," says health department director David R. Gifford, MD, MPH. "Clearly there's a culture of making mistakes, so if they're hesitant to have someone to look over their shoulder, that says to me that we're doing the right thing."

The corrective actions follow an Oct. 22 incident in which a hand surgeon scheduled to operate on two of a patient's fingers performed both surgeries on one finger. According to Dr. Gifford, the error stemmed from the fact that the patient's wrist, not each finger, were marked, and that the surgeon himself did not mark the site. Dr. Gifford says he found it particularly egregious that, once the error was discovered, the surgical staff did not take a time out before beginning a second surgery to correct itself.

This incident occurred less than 6 months after Rhode Island's hospitals and surgery centers adopted a statewide safety protocol to prevent medical errors. This effort was driven in large part by the series of wrong-site surgeries that had occurred at Rhode Island Hospital. On 3 occasions in 2007, surgeons drilled into the wrong sides of patients' skulls (for which the hospital was fined $50,000), and in 2009 a surgeon at Hasbro Children's Hospital, the hospital's pediatric division, began operating on the wrong side of a patient's mouth.

David Bernard

As mentioned above, voluntary recalls have created a nationwide shortage of propofol that will likely last months before supply quantities return to normal levels. Tell us if you're suffering short supplies of the sedative in this week's InstaPoll. We'll report the results in this space next week.

Last week, 66 of you described the precautions you're taking (if any) to combat the spread of the H1N1 flu: