Over the last decade or so, anesthesia drug shortage issues appear to have been compounding. While the passage of the 2012 Food and Drug Administration Safety and Innovation Act — which included a provision to mitigate national drug shortages — was a good move toward tackling this issue, it is still one that anesthesiologists across the country are grappling with.
Early in 2014, the Government Accountability Office released a report on drug shortages, which found anesthetic and
central nervous system drugs are among the class of drugs experiencing the highest frequently of shortages, at 17 percent of all shortages. While it noted that the FDA has improved its response to drug shortages, it also stated that "challenges remain."
"Anesthetic drug shortage affect all of us. It is an acute and a chronic problem," says William Weisberg, DO, a Sheridan Healthcare anesthesiologist and medical director for the Surgery Center of Coral Springs (Fla.).
Reasons for anesthetic drug shortages
These shortages can occur due to a wide array of circumstances, including difficulty in obtaining raw materials, drug companies changing their factory schedules as well as the government shutting down plants that manufacture these drugs for various reasons, according to David Rosen, MD, president of Chicago-based Midwest Anesthesia Partners.
"Drug shortages have reached astronomic levels," says Dr. Rosen. "And anesthetic drugs are always first or second on the list of shortages. However, it is hard to pinpoint just one or two reasons as to why that is."
Some facilities also tend to hoard drugs. If there is a potential shortage of a certain drug, then an actual shortage is created because various personnel in the hospital or surgicenters hoard the drug, says Dr. Rosen.
According to Dr. Weisberg, the legal system and bureaucratic red tape are also to blame for the high rates of anesthetic drug shortages. "The amount of bureaucratic hassle and paperwork surrounding the manufacture of anesthetic drugs can dissuade drug companies from manufacturing them — even the drugs with decades of successful use," he says.
Who are the victims of these drug shortages?
"The real tragedy at the heart of the anesthetic drug shortage issue is that patient safety is impacted," says Dr. Weisberg.
One of the biggest threats to patient safety is that when these shortages occur, pharmacies try to find a new supplier who will supply the drug in a higher quantity at a reasonable cost, says Dr. Rosen. However, the concentration of the drug by different manufacturers is different, and an incorrect does could harm the patient. "It's these kinds of problems that lead to clinical issues and is frustrating to those involved in the care of the patient," he says.
There are also certain drugs, like propofol, that can't be replaced. When there is a shortage, it's a problem that can't be overcome, says Dr. Rosen.
Mitigating anesthetic shortages
While individual anesthesiologists don't have macro-level control over the problem and can't actually prevent the shortages, there are a number of strategies they can employ in ASCs to ensure that their patients' care is not compromised as a result:
1. Find new alternatives. "ASCs know they are low on the drug vendor priority list and hospitals will get drugs before they do after a shortage," says Dr. Rosen. "This has led to a rise in using alternative methods of anesthetic care, including regional anesthesia techniques."
Regional anesthesia techniques, such as nerve blocks, are more acceptable than they were a decade ago. While the drug shortages themselves did not give rise to regional anesthesia, it has coincided with the increased use of these techniques in ASCs.
"Anesthesiologists who have been in practice for more than a decade started turning to regional anesthesia firstly because the techniques have improved significantly and also because it could help them deal with drug shortages," he says. "The drug shortages made anesthesiologists aware of the value of not putting all their eggs in one basket."
In general, drug shortages have made anesthesiologists look outside their comfort zone and find new ways to deliver care, backed by clinical data, of course, adds Dr. Rosen.
2. Look to old alternatives. According to Dr. Weisberg, anesthesiologists providing care at ASCs can look into using the same class of a drug that is facing a shortage, but an older version of it. "I have found it useful to sometimes use drugs that I used 20 years ago, which have gone out mainstream usage," he says. "Ask yourself — would I use this drug on my family? That's how to decide whether or not to give a patient a particular drug."
3. Stay on your toes. Drug shortages can happen at any time and anesthesiologists need to be extra vigilant when it comes to finding alternatives, says Dr. Rosen. Anesthesiologists also need to take note of drugs they are using and if the manufacturer has changed, because of which the concentration or the label may be different. "They need to stay on their toes everyday and be vigilant," he says.
4. Encourage patients to ask questions. Dr. Rosen also says that anesthesiologists need to be honest with their patients and encourage questions. Ultimately, honesty is the best policy. "It builds trust," he says. "I tell patients about the shortage, if there is one, and what I plan on doing about it and how it affects their procedure."
5. Consider moving patients to a hospital. In select cases, the anesthesia drug shortage may necessitate moving the patient to the hospital where the necessary drug is available, says Dr. Weisberg.
The anesthesia drug shortage issue is widespread and nuanced. It's a problem with many moving parts and cannot be fixed easily. However, it's important to discuss the issue.
"You have to understand why a problem happens in order to fix it. You have to talk about it and draw attention to it," says Dr. Rosen.
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Early in 2014, the Government Accountability Office released a report on drug shortages, which found anesthetic and
central nervous system drugs are among the class of drugs experiencing the highest frequently of shortages, at 17 percent of all shortages. While it noted that the FDA has improved its response to drug shortages, it also stated that "challenges remain." "Anesthetic drug shortage affect all of us. It is an acute and a chronic problem," says William Weisberg, DO, a Sheridan Healthcare anesthesiologist and medical director for the Surgery Center of Coral Springs (Fla.).
Reasons for anesthetic drug shortages
These shortages can occur due to a wide array of circumstances, including difficulty in obtaining raw materials, drug companies changing their factory schedules as well as the government shutting down plants that manufacture these drugs for various reasons, according to David Rosen, MD, president of Chicago-based Midwest Anesthesia Partners.
"Drug shortages have reached astronomic levels," says Dr. Rosen. "And anesthetic drugs are always first or second on the list of shortages. However, it is hard to pinpoint just one or two reasons as to why that is."Some facilities also tend to hoard drugs. If there is a potential shortage of a certain drug, then an actual shortage is created because various personnel in the hospital or surgicenters hoard the drug, says Dr. Rosen.
According to Dr. Weisberg, the legal system and bureaucratic red tape are also to blame for the high rates of anesthetic drug shortages. "The amount of bureaucratic hassle and paperwork surrounding the manufacture of anesthetic drugs can dissuade drug companies from manufacturing them — even the drugs with decades of successful use," he says.
Who are the victims of these drug shortages?
"The real tragedy at the heart of the anesthetic drug shortage issue is that patient safety is impacted," says Dr. Weisberg.
One of the biggest threats to patient safety is that when these shortages occur, pharmacies try to find a new supplier who will supply the drug in a higher quantity at a reasonable cost, says Dr. Rosen. However, the concentration of the drug by different manufacturers is different, and an incorrect does could harm the patient. "It's these kinds of problems that lead to clinical issues and is frustrating to those involved in the care of the patient," he says.
There are also certain drugs, like propofol, that can't be replaced. When there is a shortage, it's a problem that can't be overcome, says Dr. Rosen.
Mitigating anesthetic shortages
While individual anesthesiologists don't have macro-level control over the problem and can't actually prevent the shortages, there are a number of strategies they can employ in ASCs to ensure that their patients' care is not compromised as a result:
1. Find new alternatives. "ASCs know they are low on the drug vendor priority list and hospitals will get drugs before they do after a shortage," says Dr. Rosen. "This has led to a rise in using alternative methods of anesthetic care, including regional anesthesia techniques."
Regional anesthesia techniques, such as nerve blocks, are more acceptable than they were a decade ago. While the drug shortages themselves did not give rise to regional anesthesia, it has coincided with the increased use of these techniques in ASCs.
"Anesthesiologists who have been in practice for more than a decade started turning to regional anesthesia firstly because the techniques have improved significantly and also because it could help them deal with drug shortages," he says. "The drug shortages made anesthesiologists aware of the value of not putting all their eggs in one basket."
In general, drug shortages have made anesthesiologists look outside their comfort zone and find new ways to deliver care, backed by clinical data, of course, adds Dr. Rosen.
2. Look to old alternatives. According to Dr. Weisberg, anesthesiologists providing care at ASCs can look into using the same class of a drug that is facing a shortage, but an older version of it. "I have found it useful to sometimes use drugs that I used 20 years ago, which have gone out mainstream usage," he says. "Ask yourself — would I use this drug on my family? That's how to decide whether or not to give a patient a particular drug."
3. Stay on your toes. Drug shortages can happen at any time and anesthesiologists need to be extra vigilant when it comes to finding alternatives, says Dr. Rosen. Anesthesiologists also need to take note of drugs they are using and if the manufacturer has changed, because of which the concentration or the label may be different. "They need to stay on their toes everyday and be vigilant," he says.
4. Encourage patients to ask questions. Dr. Rosen also says that anesthesiologists need to be honest with their patients and encourage questions. Ultimately, honesty is the best policy. "It builds trust," he says. "I tell patients about the shortage, if there is one, and what I plan on doing about it and how it affects their procedure."
5. Consider moving patients to a hospital. In select cases, the anesthesia drug shortage may necessitate moving the patient to the hospital where the necessary drug is available, says Dr. Weisberg.
The anesthesia drug shortage issue is widespread and nuanced. It's a problem with many moving parts and cannot be fixed easily. However, it's important to discuss the issue.
"You have to understand why a problem happens in order to fix it. You have to talk about it and draw attention to it," says Dr. Rosen.
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