Last year, 267 drug shortages were reported, compared with 211 in 2010 and 58 in 2004. An estimated 15 deaths were attributed to drug shortages since 2010.1 Why is this happening and how does it affect perioperative nursing practice?
Shortages most commonly occur with generic sterile injectable drugs, including oncology drugs, anesthetics, parenteral nutrition drugs, and commonly used ED drugs.2
Determining the cause for drug shortages is difficult, but most sources point to decreased profit margins for generic drugs, product quality issues, manufacturer discontinuations, drug industry consolidation, and lack of raw materials.3
Hospitals are scrambling to meet demand for drugs affected by shortages. Recently, I attended a conference in which an ED physician was describing a situation involving a shortage of ketorolac, a nonsteroidal anti-inflammatory drug. The ED team needed to come together in order to plan for patient needs. The team completed an account of how much ketorolac was on hand, and a review of potential alternative drugs. An alert was sent to the rest of the staff to monitor ketorolac administration and minimize its use. In Connecticut, one hospital came close to canceling elective surgeries because of drug shortages.4 Situations like this are happening in many hospitals and aren't uncommon.
Hospitals may seek alternative methods or drugs for patient treatments, which may raise the risk of medication errors. For example, hospital pharmacies might be tempted to dangerous practices such as redistributing drugs from multidose vials into single-use dosages or may need to use alternative medications instead of drugs, which have been the standard drugs on the facility's formulary. Changes in packaging, variants in dosages, or alternative drugs with sound-alike names can increase the risk for mistakes during medication administration.
Then there's the issue of hoarding, maintaining an increased drug inventory, or using more-expensive substitutes, which can increase medical costs. Another source of increased costs is the "gray market," in which vendors take advantage of the shortage by buying available supplies of a drug and reselling it at tremendously inflated prices.5 A survey by the American Hospital Association found that 99.5% of hospitals had experienced drug shortages and 92% were solicited by gray-market vendors. In addition, 12% of hospitals reported adverse patient reactions from using these products.6
Most experts agree that drug shortages aren't a short-term situation. Perioperative nurses should be aware of issues that may affect patient treatment and outcomes. Vigilance in medication administration, understanding the risks associated with drug shortages, and effective communication within the surgical team will optimize patient treatments and outcomes for their patients.
Elizabeth M. Thompson, MSN, RN, CNOR
Editor-in-Chief Nursing Education Specialist Mayo Clinic, Rochester, Minn. [email protected]
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