Hospitals Grapple With Drug Shortages
Prescription drug shortages, which have dramatically increased in recent years, have hit hospital pharmacies particularly hard, according to a recent article in the Washington Post. Because advance notice of impending shortages is rare, pharmacists are forced to take last-minute measures, including diluting higher concentrations so they are usable, spreading the available supply among those who need it, and locating substitutes, which can be far more expensive than the preferred medication.
In an example described in the article, hospital staff considered substituting Factor VII, at a cost of $6000 per dose, for scarce vitamin K injections, which run just $18 per dose. In another example, pharmacy technicians spent hours diluting higher concentrations of the anesthetic midazolam to prepare a several day supply due to a shortage of the most commonly used dosages. The article reports that pharmacists now spend an average of 8 to 9 hours per week addressing shortages, compared with 3 hours per week in 2004.
An online survey conducted by the American Society of Anesthesiologists in March produced a series of disturbing results regarding shortages. Of the 3063 anesthesiologists who took part in the survey, 97.6% reported that they were currently experiencing a shortage of at least 1 anesthetic drug, up from 90% in the 2011 survey. More than 96% of respondents reported that shortages had forced them to use an alternative to their preferred drug, and more than 50% reported having altered a procedure due to shortages.
These substitutions resulted in less optimal outcomes for patients, such as postoperative nausea or vomiting (reported by 66% of respondents, up from 49.2% in 2011), and longer operating room recovery times (reported by 53% of respondents, up from 49.1% in 2011). The most dire consequences were attested to by 6 anesthesiologists, who reported that drug shortages had led to the death of a patient.