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Drug Shortages

Medications   (7,733 Views 32 Comments)
by CrufflerJJ CrufflerJJ (New Member) New Member

CrufflerJJ has 5 years experience and works as a RN - ICU.

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You are reading page 3 of Drug Shortages. If you want to start from the beginning Go to First Page.

RNsRWe works as a Registered Nurse.

3 Articles; 88,935 Visitors; 10,428 Posts

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.

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NotReady4PrimeTime has 25 years experience as a RN and works as a RN, CNCCP(C).

16 Articles; 71,212 Visitors; 7,351 Posts

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.

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RNsRWe works as a Registered Nurse.

3 Articles; 88,935 Visitors; 10,428 Posts

..... 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?

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NotReady4PrimeTime has 25 years experience as a RN and works as a RN, CNCCP(C).

16 Articles; 71,212 Visitors; 7,351 Posts

That's what I'm saying.

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RNsRWe works as a Registered Nurse.

3 Articles; 88,935 Visitors; 10,428 Posts

Gotcha. And it makes sense.

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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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0.9% Normasaline, simple isotonic salt water that is used on a daily basis on every med - surg floor in if not the world, then this country. Why is it so difficult to keep in stock. Baffled!

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NotReady4PrimeTime has 25 years experience as a RN and works as a RN, CNCCP(C).

16 Articles; 71,212 Visitors; 7,351 Posts

Probably because your inventory control people have determined that in an average supply cycle your unit uses x number of bags, back in the day when patients weren't as ill as they are now, no changes have been made to the standing order, and now you're using 2x number of bags per supply cycle. Our unit has this problem with a number of supply items, one in particular that has been a big problem. The administration has opened 10 more beds and split our unit into two physically separate areas. The base number of urometers has remained unchanged. In the meantime, we've been using manual peritoneal dialysis more and more and a practice change now has us changing the whole PD setup q day. If we have several patients on PD at the same time, we run out of urometers on a regular basis. Our patient care manager didn't understand the problem and when asked to adjust our standard supply, she got even more confused. So on it goes.

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