Hospitals and surgery centers across the country are struggling with shortages of critical anesthetics and other drugs. A recent survey by the American Society of Anesthesiologists found more than 90 percent of anesthesiologist respondents are currently experiencing a shortage of at least one anesthetic. John Dombrowski, MD, a member of the ASA Board of Directors and chair of the ASA Committee on Communications, shares four ways anesthesiologists and facilities can tackle the drug shortages.
1. Collaborate with facility leaders. Dr. Dombrowski says the most important aspect of tackling a drug shortage is promoting collaboration between hospital or surgery center leaders and anesthesia providers. "I think often, the CEO, CFO or pharmacy head doesn't realize the resources they have in an anesthesiologist," he says. "They're not just the people in the OR that put you to sleep. They're involved in perioperative medicine before, during and after surgery."
He says hospitals and surgery centers should work with anesthesiologists to brainstorm ways to weather the shortage. This may include ordering different drugs or understanding that some cases may need to be delayed or cancelled. Anesthesiologists will probably be able to offer numerous suggestions for drug substitutions, knowledge that the hospital or ambulatory surgery center leader might not have if they lack an anesthesia background.
2. Don't panic and hoard drugs. When a drug shortage is announced, Dr. Dombrowski says some facilities may panic and decide to order as many of the affected drug as possible. This may alleviate the shortage for that facility, but he says hoarding drugs exacerbates the shortage for the rest of the industry and damages anesthesia care nationwide. The American Society of Anesthesiologists study found that nearly half of patients who underwent procedures during a drug shortage experienced less than optimal outcomes, such as increased frequency of nausea, longer operating room and recovery times and increased healthcare costs. Providers who stockpile drugs increase the likelihood of these negative effects for patients across the country.
Dr. Dombrowski believes the problem of hoarding could be corrected with better communication between stakeholders. "We need better communication skills to say, 'We've got a production problem, and we're fixing it. Don't hoard drugs because we'll get it resolved,'" he says. He says the FDA and the ASA are working together to develop 'action alerts' that let providers know the severity of a drug shortage.
3. Look for workarounds when appropriate. Anesthesiologists are highly trained physicians with sufficient medical knowledge and experience to know when certain drugs or treatments in short supply can be substituted, Dr. Dombrowski says. According to the ASA survey, more than 91 percent of respondents have been able to work through the drug shortages by using alternative medications. For example, the nationwide shortage of Propofol has prompted providers to use sodium pentothal as a substitute. While the patient experience may be less comfortable with sodium pentothal, the drug is still safe to use in place of Propofol while the shortage persists. Providers have also turned to regional anesthesia when general anesthesia is not possible, using spinal or epidural anesthetics to numb the patient without putting them to sleep.
"A lot of medicine is not cookbook medicine, and having a medical background, you can decide to do it one way or another way," Dr. Dombrowski says. "There's no algorithm." He says the shortage can push providers to consider creative alternatives. For example, if a facility is experiencing a shortage of a reverse muscle relaxant that acts as the antidote to a muscle relaxant, the anesthesiologist might consider whether he or she needs to give the patient the muscle relaxant in the first place.
4. Cancel cases when necessary. Dr. Dombrowski says anesthesiologists and surgeons should communicate about whether a drug substitution is appropriate for a particular surgery. If the substitution could endanger patient safety, the providers should not hesitate to cancel or reschedule the case. "Sometimes there's no workaround, and you have to say to the patient, 'After looking at your past medical history and your condition, what we would need to provide you is not really safe,'" he says. According to the ASA survey, approximately 10 percent of respondents have postponed or cancelled procedures as a result of the shortages.
Learn more about the American Society of Anesthesiologists.
Related Articles on Drug Shortages:
Pharmacists and Physicians Struggle to Cope With Drug Shortages
ASA Survey: Over 90% of Anesthesiologists Face Drug Shortages
Drug Makers Suspend Production of Phenylephrine
1. Collaborate with facility leaders. Dr. Dombrowski says the most important aspect of tackling a drug shortage is promoting collaboration between hospital or surgery center leaders and anesthesia providers. "I think often, the CEO, CFO or pharmacy head doesn't realize the resources they have in an anesthesiologist," he says. "They're not just the people in the OR that put you to sleep. They're involved in perioperative medicine before, during and after surgery."
He says hospitals and surgery centers should work with anesthesiologists to brainstorm ways to weather the shortage. This may include ordering different drugs or understanding that some cases may need to be delayed or cancelled. Anesthesiologists will probably be able to offer numerous suggestions for drug substitutions, knowledge that the hospital or ambulatory surgery center leader might not have if they lack an anesthesia background.
2. Don't panic and hoard drugs. When a drug shortage is announced, Dr. Dombrowski says some facilities may panic and decide to order as many of the affected drug as possible. This may alleviate the shortage for that facility, but he says hoarding drugs exacerbates the shortage for the rest of the industry and damages anesthesia care nationwide. The American Society of Anesthesiologists study found that nearly half of patients who underwent procedures during a drug shortage experienced less than optimal outcomes, such as increased frequency of nausea, longer operating room and recovery times and increased healthcare costs. Providers who stockpile drugs increase the likelihood of these negative effects for patients across the country.
Dr. Dombrowski believes the problem of hoarding could be corrected with better communication between stakeholders. "We need better communication skills to say, 'We've got a production problem, and we're fixing it. Don't hoard drugs because we'll get it resolved,'" he says. He says the FDA and the ASA are working together to develop 'action alerts' that let providers know the severity of a drug shortage.
3. Look for workarounds when appropriate. Anesthesiologists are highly trained physicians with sufficient medical knowledge and experience to know when certain drugs or treatments in short supply can be substituted, Dr. Dombrowski says. According to the ASA survey, more than 91 percent of respondents have been able to work through the drug shortages by using alternative medications. For example, the nationwide shortage of Propofol has prompted providers to use sodium pentothal as a substitute. While the patient experience may be less comfortable with sodium pentothal, the drug is still safe to use in place of Propofol while the shortage persists. Providers have also turned to regional anesthesia when general anesthesia is not possible, using spinal or epidural anesthetics to numb the patient without putting them to sleep.
"A lot of medicine is not cookbook medicine, and having a medical background, you can decide to do it one way or another way," Dr. Dombrowski says. "There's no algorithm." He says the shortage can push providers to consider creative alternatives. For example, if a facility is experiencing a shortage of a reverse muscle relaxant that acts as the antidote to a muscle relaxant, the anesthesiologist might consider whether he or she needs to give the patient the muscle relaxant in the first place.
4. Cancel cases when necessary. Dr. Dombrowski says anesthesiologists and surgeons should communicate about whether a drug substitution is appropriate for a particular surgery. If the substitution could endanger patient safety, the providers should not hesitate to cancel or reschedule the case. "Sometimes there's no workaround, and you have to say to the patient, 'After looking at your past medical history and your condition, what we would need to provide you is not really safe,'" he says. According to the ASA survey, approximately 10 percent of respondents have postponed or cancelled procedures as a result of the shortages.
Learn more about the American Society of Anesthesiologists.
Related Articles on Drug Shortages:
Pharmacists and Physicians Struggle to Cope With Drug Shortages
ASA Survey: Over 90% of Anesthesiologists Face Drug Shortages
Drug Makers Suspend Production of Phenylephrine