Drug Shortages - page 3

by CrufflerJJ 5,050 Views | 31 Comments

Last week, I spoke with my father about drug shortages - whether they really exist in our hospitals. The brief answer is YES. Drug shortages not only exist in hospitals, but also in "the field", as seen by EMS providers.... Read More


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    Quote from 8mpg
    I also believe a large part of the problem is JACHO rules about single dose vials even for the same patient. I work in an ICU and am sick of wasting drugs. I have a patient tonight that gets Versed PRN Q1H 2mg. We have 5mg vials. The correct thing to do is waste 3mg every hour. Versed is often on backorder for our hospital. Same goes for morphine. I remember for a while we had 8mg syringes only and would waste 6-7mg of morphine each dose.
    Boy, am I with you on this one! You can't help it if you need 2-3mg of something and there's only a 5mg vial, but at least most of the time they're q4h meds so....ok. But something like you're describing is just a disgusting waste.....and MY unit really needs 2mg amps of Versed, because we typically only USE 2 mg, sometimes 3, rarely 4. And now, I currently have some 5mgs left....and next in line are 50mg/10ml bottles. Seriously?? Changing the concentration, too, means a pita. Thankfully we don't use JACHO; our accreditation body recognizes the med problem and ok's multi-doses under carefully-scrutinized circumstances. So far, we haven't run out of anything just yet...
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    Quote from 8mpg
    I also believe a large part of the problem is JACHO rules about single dose vials even for the same patient. I work in an ICU and am sick of wasting drugs. I have a patient tonight that gets Versed PRN Q1H 2mg. We have 5mg vials. The correct thing to do is waste 3mg every hour. Versed is often on backorder for our hospital. Same goes for morphine. I remember for a while we had 8mg syringes only and would waste 6-7mg of morphine each dose.
    For a while, we were out of the 100 mcg vials of fentanyl in our ICU. WHEN we could get the med, it was in 250 mcg "party bottles". Draw out 50-100 mcg, waste the rest.
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    "party bottles"....LOL.....!
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    Quote from RNsRWe
    Boy, am I with you on this one! You can't help it if you need 2-3mg of something and there's only a 5mg vial, but at least most of the time they're q4h meds so....ok. But something like you're describing is just a disgusting waste.....and MY unit really needs 2mg amps of Versed, because we typically only USE 2 mg, sometimes 3, rarely 4. And now, I currently have some 5mgs left....and next in line are 50mg/10ml bottles. Seriously?? Changing the concentration, too, means a pita. Thankfully we don't use JACHO; our accreditation body recognizes the med problem and ok's multi-doses under carefully-scrutinized circumstances. So far, we haven't run out of anything just yet...
    I can't believe there are nurses who still do not see the value in single use vials.

    I wonder what the patients with Hep C in the Vegas clinic, which helped to result in the infamous propofol shortage, would say about multidose bottles.

    The problem is with the shortage, not with the safety rules.
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    Quote from Asystole RN
    I can't believe there are nurses who still do not see the value in single use vials.

    I wonder what the patients with Hep C in the Vegas clinic, which helped to result in the infamous propofol shortage, would say about multidose bottles.

    The problem is with the shortage, not with the safety rules.
    I see the value of single-use bottles, as evidenced by my post you quoted; it is my clear preference. It is not, however, for safety reasons but for waste/ease of administration reasons. The problem is not multi-dose bottles; they're an infection problem only when NOT following the safety rules. And we follow those rules just fine, thanks.

    The patients who got Hep C were treated by people who did not follow any semblance of those rules. Actual, criminal conduct was involved. Hep C does not simply appear in a multi-dose vial through careful, standard practices of infection control.

    Using a new sterile needle/syringe to draw from an alcohol-swabbed bottle, tossing the needle/syringe and using a second sterile needle/syringe in NO WAY can give ANYONE Hep C.

    I can't believe there are nurses who don't know how the pathway to infection works.
    sapphire18 and kabfighter like this.
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    The current shortage of garden-variety injectable drugs stems from a production line issue at Sandoz's manufacturing plant. They had one production line that was closed for maintenance and then were required to close a second line due to failings found on inspection. It will take them the better part of a year to get the two lines back up and running. I work in a PICU; the way we've chosen to cope with the shortage is to minimize waste wherever possible. RAther than mixing up several days' worth of some infusions we mix up 24 hours worth. If the infusion is discontinued then we're not throwing away a significant volume of drug. We also draw up the entire content of ampoules (Lasix, morphine, fentanyl etc) into a sterile syringe, label it with the patient's name and tape the empty ampoule to the syringe before storing it in the patient's medication bin. Then we can use the whole ampoule over the course of a shift, only wasting at the end of the shift. We've made some substitutions; rather than use IV Maxeran for placement of small-bore post-pyloric feeding tubes, we'll use enteral Maxeran and give it an hour before we want to drop the tube. We've replaced IV ranitidine with IV famotidine. We transition patients from infusion meds to enteral ones as soon as is practicable. There are ways around the issue. It just takes some out-of-the-box thinking.
    sapphire18 likes this.
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    Quote from janfrn
    ..... We also draw up the entire content of ampoules (Lasix, morphine, fentanyl etc) into a sterile syringe, label it with the patient's name and tape the empty ampoule to the syringe before storing it in the patient's medication bin. Then we can use the whole ampoule over the course of a shift, only wasting at the end of the shift.
    This worries me a touch. Having grown up on the teaching "if you didn't draw it up, you don't administer it", I'm not sure how comfortable I'd feel giving something from a syringe that SAYS it's Lasix/morphine/whatever.....but how do I know that's what it is? Then again, I know the answer is I wouldn't.

    Unless you're talking about only ONE nurse giving from that syringe...? And that way just wasting her own meds at the end of the shift?
    Szasz_is_Right likes this.
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    That's what I'm saying.
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    Gotcha. And it makes sense.
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    Quote from HM-8404
    What is sad is that so many people, and their lawyers, see the right lawsuit, against the right company, as a retirement plan.
    So then, are there valid cases of malfeasance on the part of corporations, with their fiduciary responsibility strictly to the shareholders, or is that just a bunch of lefty propaganda? If a company decided to cut a safety corner to increase their profit, and that decision costs someone their career, is it tough luck for the victim? Should he just stop whining (if he still has the power of speech)?

    Of course there is abuse of the system, as there is in all human systems. So what is the solution? To blow it up?


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