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Archive November 2020 XXI, No. 11

Safety: Managing Medication Shortages

Planning for drug scarcities ensures you deliver safe patient care.

Allen Vaida

Allen Vaida, PharmD, FASHP


Pamela Bevelhymer, RN, BSN, CNOR
DAILY UPDATES Check websites that monitor drug shortages and communicate with medication supply reps to avoid running out of critical medications.

Some of the drugs and fluids used most often in surgical facilities go in and out of shortage daily due to interruptions in the supply chain, a problem exacerbated by the COVID-19 pandemic. Fentanyl for pain control has been in shortage lately, as have some benzodiazepines used for sedation, cardiac medications, diuretics and blood pressure meds. Dextrose and saline fluids are also proving difficult to stock. If your facility doesn't have protocols in place to plan for shortages before they occur, now is certainly the time to create them. Start with these five steps to ensure the drugs needed to provide safe patient care are always on hand, even when supply streams slow to a trickle.

1Monitor supplies
SThe American Society of Health System Pharmacists works closely with the FDA and maintains the most current drug shortage list ( It should be checked daily. The FDA also has daily information on shortages at ( You can also sign up for twice weekly email updates from the FDA on shortages. The Institute for Safe Medication Practices ( and our parent organization ECRI Institute ( has useful information about shortages as well. Check these sites on a regular basis. They're helpful in assessing the current supply levels of your often-used medications and can help you react to potential shortages before they impact your stock.

2Know your inventory
Keep a current list of your most commonly performed procedures and what medications are used for them, and your surgeons' preferred medications. When ordering medications, refer to the list to determine what medications are needed for cases during the upcoming week.

The list should include the primary medication used for all procedures and the second- and third-line options in the event there's a shortage of the medication of choice. Maintain standard order sets (SOS) for your workhorse medications as well as for your facility's secondary and tertiary choices. The order sets are critical clinical tools that have dosage recommendations on them. Many medication errors occur when providers make dosing errors with medications they're not used to administering. If a large orthopedic center typically uses morphine, but pivots to hydromorphone because of a morphine shortage, the dosage is less because the substitute is more powerful. If fentanyl is used as a replacement, it's even more potent, so the dosage is smaller still. These backup medications aren't unsafe. You just have to follow the dosage noted in the SOS so errors don't occur.

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