Message from the President-April 2018

Posted on Apr 6, 2018 in President's Message | 0 comments

Welcome back to another edition of the medical staff newsletter! As many of you know, we have been encountering shortages of both medications and supplies. Medications have included items such as amiodarone, many antibiotics, KCL, local anesthetics, and compounded medications including drips and epidural solutions. If possible, please use oral medication for your patients, saving the limited supply of IV medications for those patients who need it the most. Also, please call ahead to pharmacy if you anticipate needing a compounded medication, such as a drip. Regarding supplies, we have experienced shortages of IV bags, sterile irrigation solution, connectors, extension sets, adaptors, stopcocks, and many more items.

Currently, we have limited allocations of certain drugs and supplies from many companies. The landscape changes weekly, and sometimes daily. Every now and again, we avert a crisis with an unexpected allotment. Emergency teams are pulled together immediately to address this ever-changing atmosphere of shortages as needed. Thank you to everyone who has participated on these teams. As this is a fluid situation, please look for the rainbow colored icon, located on every ABSMC computer, titled “Supply Backorders” listing both the current medication and supply shortages. We asked about sharing medications and supplies with other Sutter hospitals. Unfortunately, they too are on limited allotments from manufacturers and often do not have extra supplies or medications to share. Sutter has a committee, above the affiliate level, coordinating efforts whenever possible.

What has lead up to these issues? Well, there are many factors. I’ll touch on a few. Pfizer’s Kansas facility experienced quality problems leading to an almost full shut down of its major production facility impacting availability of opoids and local anesthetics. The Baxter manufacturing facility in Puerto Rico, damaged during hurricane Maria, lead to shortages in small volume drug bags. The FDA did take action to import supplies from other manufacturers located in other countries, which eased some of the supply issues.

As part of an effort to decrease misuse of opiod pain killers, the DEA called for a 25% reduction in the manufacturing of opoids last year, and an additional 20% reduction this year. This, along with the manufacturing issues at Pfizer’s Kansas facility, has led to opoid shortages. Many hospital systems across the country are experiencing opoid shortages, causing staff either to be judicious with usage and using alternative medications that are less potent, or, if available, giving alternative opoid medications in concentrations that RNs are unfamiliar. As a result, there have been reports from other hospitals of inadequate pain control, elective surgery cancellations, and overdoses due to lack of familiarity and mistakes in dosage administration. A letter was written on February 27, 2018 jointly by the American Hospital Association, the American Society of Clinical Oncology and the American Society of Health-System Pharmacists to the US Drug Enforcement Administration stating that the shortages “increase the risk of medical errors” and are “potentially life threatening”. The American Society of Anesthesiology is working with other national organizations to address these issues and stay ahead of drug shortage problems. They have been a leading advocate in Congress and are partnering with the FDA and their Office of Drug Shortages to monitor these issues and work toward solutions. So far, our hospital has not been significantly affected by opoid shortages.

On February 27, 2018, the California State Board of Pharmacy sent a Cease and Desist order to Pharmedium Services as an investigation demonstrated noncompliance with state regulations and federal good manufacturing practices. The California Pharmacy Board is currently working to identify alternative manufactures and alternative strategies in lieu of Phamedium sterile compounded and nonsterile drug products. This has placed an enormous burden not only on our pharmacy, but on all hospital pharmacies in California. At a recent ABSMC committee meeting pharmacy stated that we went from compounding 10% of compounded drugs to compounding 90% of compounded drugs in our pharmacy. What this means: first, the increase in compounding medication on site is a large burden for the pharmacy staff. Second, drugs compounded on site have a 12 hour shelf life, limiting the number of premade compounded medications available on demand. The company has 30 days to respond to this issue and hopefully we will see a resolution soon. In the meantime, please call ahead to pharmacy, if possible, if you need a compounded medication, such as a drip, STAT. Also, please give your pharmacy colleagues a kind word for their hard work.

Jill Kacher Cobb, MD

President of the Summit Medical Staff, ABSMC

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