Critical Drug Shortages in Colorado

July 27, 2010
From the desks of: Stephen T. Brown, III, MD, CME, Centura Health; and Sharon Pappas, RN, PhD, NEA-BC, CNE, Centura Health

This message is intended for all Centura Health associates and physicians.

Critical drug shortages

Centura Health and healthcare facilities across the nation are seeing unprecedented shortages of critical drugs such as propofol, morphine, epinephrine and hydromorphone. There is a possibility that we may experience stock depletion of critical drugs in the weeks ahead. These drug shortages are occurring due to a combination of manufacturing issues (raw material shortages, contaminants, quality/safety enforcement) and business decisions that lead to market concentration with only one or two producers.

Understanding actual drug shortages is challenging because drug manufacturers are not required to post shortages unless they are the sole source provider of the drug or the drug is deemed critical. Even then, manufacture lists are not always accurate.

Propofol

Propofol is widely used in medical and surgical procedures for its ability to produce rapid, deep sedation. For many hospitals, propofol has become the drug of choice in many protocols and practices and is widely used outside the operating room for a number of other procedures where a deeper conscious sedation is desired.

Depending on the clinical situation, alternatives to propofol could include midazolam, lorazepam, methohexital, ketamine or etomidate, among others. Certainly, in procedures using an alternative for conscious sedation, drugs can have added risks due to the changes for ordering, dispensing, storing, diluting, dosing and recovery.

Our Response

Our priority is to ensure that patients receive care that is always safe, effective and meets evidence-based standards. In situations of limited or scare resources such as we are experiencing with critical drug shortages, we must work together to ensure that we conserve and share resources to meet critical patient needs within our organization and across the system.

The Centura Pharmacy Directors are working on a central database for tracking critical drug supplies within our system as well as developing contingency plans to anticipate and address critical drug shortages. This plan will include:

• Preservation and conservation strategies for anticipated drug shortages,
  
  
• Alternative drug protocols for critical shortages including when these protocols will go into effect
  
  
• Protocols for staff education and training in use of alternative drugs.
  

We extend the healing ministry of Christ by caring for those who are ill and by nurturing the health of the people in our communities.

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