The incredible shrinking anesthesia supply

January 12th, 2015

We are all well aware of the drug shortages. Have you thought about the impact it could have on patient safety? According to a report that is due to appear in the December issue of Anesthesia & Analgesia, the United States is facing ongoing shortages of several critical anesthesia medications, so it is no surprise that these shortages can have severe effects on patient care and safety.

Over the last 10 years, the reported incidences of medication shortages have become increasingly frequent. In 2010, the American Society of Health-System Pharmacists (ASHP) listed 140 medications in short supply, and those include alternative drugs as well.

The easy answer is, just make more of the drug, but many factors contribute to medication shortages including product recalls, shortages of raw materials, and a surge in demand. Shortages are especially acute for sterile injectable medications because of the many complex steps involved in their manufacture. Current inventory management practices, such as short inventories and "just-in-time" production schedules, also play a role.

As expected, drug shortages can have an overwhelming impact on patient safety. Patients may face treatment delays, have procedures canceled, or receive alternative drugs that are less effective or have more side effects. The study noted that "Drug shortages can therefore increase risks to patients, and can also have a negative impact on institutions."

Of special concern to anesthesiologists is the shortage of propofol, which seems strange because Dr. Conrad Murray didn’t seem to have a problem getting his hands on the drug. In any event, anesthesiologists need to be aware of ASHP guidelines for dealing with medication shortages and play an active role in developing and implementing the response at local hospitals. They should report shortages, especially the ones that have great impact on patient care.

Healthcare professionals can also inform the Food and Drug Administration (FDA) about potential drug shortages. Depending on the cause, the FDA may take steps to alleviate shortages. Steps should be taken now to prevent shortages of anesthesia drugs from becoming a public health issue. These may include increasing inventories, implementing policies and legislation to increase drug production, and regulatory changes affecting drug manufacturing.

The American Hospital Association supports legislation such as the Preserving Access to Life Saving Medications Act (H.R. 2245/S. 296), which would give the FDA tools to better manage drug shortages and prevent them in the future. According to a recent AHA survey, more than 99% of hospitals reported a drug shortage in the previous six months, and 92% reported increased drug costs as a result.