Worsening drug shortages leave providers scrambling for alternatives
Dr. James Augustine receives a daily report that shows which drugs are in short supply. Last week, 115 emergency medications were unavailable.
Augustine, an emergency physician who works at Mercy Health hospitals in Cincinnati, said some 40 injectable opiates, 50 IV solutions and a variety of other drugs peppered the report from the distributor Bound Tree Medical.
These shortages of widely used treatments for heart surgery, dehydration, pain management, nausea and other ailments compromise nearly all types of care. It's a week-to-week guessing game on what drug shortage may surface next, Augustine said.
"The very basic things hospitals need to do their business are unavailable for unexplainable reasons," said Augustine, who is also on the board of the American College of Emergency Physicians.
Augustine's experience represents a troubling reality for nearly all providers—they must spend more time working around drug shortages. That means they spend less time with the patient, who may receive a more expensive but less effective treatment.
Ninety-one percent of nearly 250 emergency physicians surveyed in a new ACEP poll said they had experienced a shortage or absence of critical medicine in their emergency department in the past month.
More than one-third said patient outcomes have been negatively affected as a result. Nearly 90% said they have had to take time away from patients to deal with these shortages while 97% said they had to substitute medications.
"It is probably worse than it appears because the pharmacy deals with so much in the background that physicians don't even see," said Scott Knoer, Cleveland Clinic's chief pharmacy officer. "We are constantly scrambling behind the scenes."
Cleveland Clinic plans to build a 503B-compliant compounding facility that would allow it sell drugs to other hospitals, Knoer added.
Intermountain Healthcare, Ascension, SSM Health and Trinity Health are working with the U.S. Veterans Affairs Department to pool their capital and 450 total hospitals to form their own generic-drug company to combat shortages and rising drug prices. This could spur other healthcare organizations to produce more goods themselves and force more responsible pricing behavior, said Augustine, adding that importing drugs from other countries could also help.
More states are exploring legislation that could allow them to import drugs from Canada, with the federal government's approval. But critics argue that importing drugs would compromise patient safety.
Despite the U.S. Food and Drug Administration's attempts to improve communication between drug manufacturers, regulators and providers, mitigating a drug shortage is still largely a reactive process, experts said.
"We usually don't know there's a problem until there's a problem," Knoer said.
Drug shortages are expensive and they often lead to mistakes. Providers have had to reconfigure crash carts and other trauma toolkits, which means that it may take longer for first responders to find a drug during an emergency. All this requires thorough staff training, new processes and constant surveillance.
The new survey indicates that drug shortages are a growing problem. Over the past year, nearly 70% of the respondents said drug shortages have increased a lot, while 16% indicated they have increased a little.
Eighty-four percent reported that they have experienced shortages of between one and 10 medicines over the past month. Eight percent said they manage 11 to 15, 3% said they manage 16 to 20, and 5% said they work with 20 or more.
"There is a lot of wasted time and energy and that delays patient care," Augustine said.
Bee sting season is around the corner, Augustine said. But EpiPens, which are used to treat stings and other events that produce strong allergic reactions, are in short supply across the country.
"We give parents a prescription for this life-saving medicine, but I have to look them in their eyes and tell them, 'I don't know if you can find this. And depending on insurance this could cost $500, $600, $700 out of pocket.' That is really hard to do," Augustine said. "It's just about unthinkable that this is a problem."
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