Hospitals and health systems have had to pull injectable drugs like sodium bicarbonate off crash carts. The sterile form of baking soda is used during advanced cardiac life support and as an antidote to some poisons. The shortage has delayed heart surgeries and compromised other emergency events when a patient's blood is too acidic, which can be fatal without proper treatment.
Cleveland Clinic is always managing anesthetics as well as emergency syringes like epinephrine, sodium phosphorite and lately opiate injectables, although those have gotten better, said Chris Snyder, a Cleveland Clinic pharmacist and drug shortage specialist.
“There have been tremendous issues with lidocaine and bupivacaine,” Snyder said. “This is probably the worst we have ever seen in the local anesthetic market.”
Civica Rx plans to deliver 14 generic drugs to hospitals and health systems in 2019. It is focused on older sterile injectable drugs, said Martin VanTrieste, CEO of Civica Rx and a former Amgen executive.
The drugs in short supply can vary, though shortages of bupivacaine and lidocaine have persisted since 2011, said Erin Fox, a drug supply expert who's senior director of drug information and support services at University of Utah Health.
Calcium chloride, which is commonly stocked in crash carts for resuscitation, has also been in short supply since 2011. Calcium gluconate, an essential ingredient in IV nutrition for premature babies, seriously ill adults and dialysis patients, has been short since 2012. Cardiac arrhythmia-stopping potassium chloride also has been persistently scarce since 2012.
Shortages of antibiotics used primarily in hospitals for very sick patients like piperacillin-tazobactam have been occurring since 2013 and cefepime since 2014. Sometimes hospitals couldn't get a specific size, and in other cases they couldn't obtain any product, forcing a switch to other antibiotics, Fox said.
These shortages can cost hospitals valuable resources. Finding new suppliers can lead to errors, safety issues or delayed surgeries. Because EHRs require the use of the exact same product in size, formulation and strength, any needed changes due to shortages can require hundreds of hours of updates, she said.
“The key issue is inadequate capacity in manufacturers that are willing to make basic hospital products,” Fox said.
Ochsner Health System in New Orleans has seen the frequency of drug shortages significantly increase over the past several years, said Dr. Robert Hart, the system's executive vice president and chief medical officer. “We have resources constantly looking for where the next problem is going to be,” he said.
More than 90% of about 1,200 surveyed hospitals reported having to identify alternative therapies to mitigate the impact of drug price increases and shortages, according to a new report from the American Hospital Association, the Federation of American Hospitals and the American Society of Health-System Pharmacists. A quarter of hospitals had to cut staff to mitigate budget pressures as average drug spending increased by 18.5% between 2015 and 2017. That rate tripled overall medical inflation over that period, resulting in $1.8 million in new spending for an average hospital. Specifically for drugs in shortage in 2016, average unit prices increased 23.4%.