Drug shortages are increasing, so outpatient surgery programs must develop strategies for dealing with them, advises Jan Allison, RN, CHSP, of Washington, OK, director of accreditation and survey readiness for Surgical Care Affiliates.
“A challenge is determining if the facility is able to establish a process that complies with the guidelines for accessing the multi-dose vial outside the immediate patient care area,” Allison says. Don’t use the product beyond the designated expiration date, she says. (See more information about Allison’s position in story included in this issue.)
Sheldon Sones, RPh, FASCP, a pharmacy consultant based in Newington, CT, often is asked what to do about discarding partially used vials if products aren’t available or are in short supply.
“I continue to reiterate the standard,” Sones says. “Yet what some facilities have opted to do is to, on a case-by-case basis, make a judgment in the best interest of patients considering the drug entity and the emergent status of need, whether alternative drugs exist, in collaboration with the medical director and/or the anesthesia provider.” [See Sones’ sample policy enclosed with this month’s online issue of SDS. For assistance, contact our customer service department at (800) 688-2421 or customer.service@AHCMedia.com. This policy is presented to facilitate discussion. SDS doesn’t advocate any practice that is in opposition to Drug Enforcement Administration or accreditation standards.]
Sones points out that some vials that appear to be multiple dose are, in fact, single-dose vials. He points to esmolol (Brevibloc) and metoprolol, as well as configurations of lidocaine, bupivacaine, and propofol.
“On entry into a multiple-dose vial, it should be swabbed with an alcohol swab using friction,” Sones says.
Regulations need to change and procedures need to be put into place so valuable medications aren’t wasted, says Mark Mayo, CASC, executive director of Golf Surgical Center in Des Plaines, IL.
Sones “Option B” policy includes the following wording: “If, in the opinion of medical, clinical, and administrative leadership, multiple dose vials [MDV] must be maintained in the facility and utilized within patient care areas, by consensus conclude that patient access would be denied and thus compromise patient care if MDV drugs in short supply are routinely discarded after each patient use in said patient care areas, the facility may opt to temporarily and judiciously maintain these MDV."
Mayo says, “I suspect that some providers already follow Option B out of necessity, not out of greed, because medication shortages are a real, and weekly, problem in healthcare delivery.”