Acetylcysteine Inhalation Solution

Transcription

1 Drug Shortage information Action Plan delays and another manufacturer voluntarily suspending production. Hospira has a limited supply available and other manufacturers are unable to estimate a release date. Acetylcysteine Inhalation Solution Acyclovir Inj Atropine Inj A few manufacturers suspended their production leading to this shortage. Currently no products are available. Manufacturers have suspended the production leading to delays. CPOE alert implemented asking prescribers to utilize alternative for inhalation orders. PO/IV is currently restricted to acetaminophen overdose in adults, regardless of shortage. Memo distributed, posted on Methodist MD. Shortage reviewed at Dec P&T that includes ganciclovir as an alternative. Using vials for EH carts and trays. Black Widow Antivenin Bleomycin Calcium chloride and calcium gluconate Cytarabine Merck has low inventory of Antivenin Latrodectus Mactans. The company cannot estimate when regular distribution will resume. The shortage is due to manufacturer discontinuing the product in May 2011 and increased demand by other manufacturers. 15 unit and 30 unit vials available in limited supply. Shortage is due to manufacturing problems issues. Memo created and sent to ED staff and pharmacy on process on how to obtain emergency supply through Merck. Merck (medical team) If after normal business hours, contact the same number and follow prompts A communication letter has been sent to oncologists/hematologists to notify them of the shortage. Alternatives: For Hodgkin's Lymphoma, omit bleomycin or use an alternative regimen. For testicular cancer, use the EP or VIP regimen. See Chemo action plan for plans on select critical chemo shortages-approved by P&T Conservation plan implemented for TPN and boluses. CPOE alert on calcium gluconate to alert prescribers. Calcium chloride stock reduced/removed from emergency carts/procedural trays. Some products are available. Alternatives: For AML, use Mitoxantrone+Etoposide. For ALL, use alternative regimens or omit Cytarabine. See Chemo action plan for plans on select critical chemo shortages-approved by P&T.

2 Daunorubicin Doxorubicin Epinephrine The shortage is due to suspension of manufacturing and manufacturing issues. issues. The duration of the shortage is issues. The duration of the shortage is currently A communication letter has been sent to oncologists/hematologists to notify them of the shortage. Use alternative anthracycline or an alternative regimen for lymphomas, metastatic breast cancer, or sarcomas. A communication letter has been sent to oncologists/hematologists to notify them of the shortage. Use alternative anthracycline or an alternative regimen for lymphomas, metastatic breast cancer, or sarcomas. The epinephrine count on the Emery House carts has been decreased from 10 to 5. Slips were placed in the EH cart as reminders. Foscarnet Hospira has presentations on hold due to quality improvement activities. Hospira cannot estimate a release date. FDA allowing temporary importation of Foscavir from Clingen Healthcare in the United Kingdom. Product available at wholesaler and stock is being obtained for system by University. Fosphenytoin Akorn and American Regent no longer manufacture. Hospira had a voluntary recall. Other manufacturers reason Stock low. There is a CPOE order alert active, asking prescribers to utilize alternatives: Alternative injectables include (adult dosing): Phenytoin injection (use same dose and frequency as fosphenytoin) Levetiracetam (Keppra) 20mg/kg load; 1000 mg bid for prophylaxis/maintenance dose Valproate sodium 20mg/kg load; mg/kg/day divided q8-12 hours maintenance dose Phenobarbital 20mg/kg load; mg BID or TID maintenance dose

3 Furosemide and manufacturing delays. Stock is being tracked on a weekly basis. Prescribers are encouraged to order po over IV where possible. If IV is clinically necessary, a 48 hour automatic stop will be applied. A CPOE order alert is active for the shortage with conversion information for IV to po as it is not a 1:1 conversion. Influenza vaccine Shortage is due to increased demand. Prefilled syringes are short supply of multi-dose vials is adequate to meet expected needs for remainder of season. When supply of prefilled syringes is exhausted, will switch to draw-on-demand. Intravenous fat emulsion Kanamycin Labetalol Leucovorin inj Mannitol Nimodipine and manufacturing issues. APP is unable to obtain raw materials to manufacture kanamycin injection. APP has on long term backorder with no estimated release date. There are no other presentations available. delays. and manufacturing issues. and manufacturing delays. The expected duration of the shortage is Manufacturers cannot provide a reason for this shortage. Some stock has been available lately but a limited supply is available. Conservation plan is in place. Patients on long-term TPN will receive IV lipids on Tuesdays and Fridays. See plan for further details. Removal of Kanamycin from heart boxes approved by anesthesia No carpujects available doses will be drawn up in IV room and dispensed on demand. P&T approved pharmacist interchange from leucovorin to levoleucovorin if needed. Leucovorin tablets are currently available and are not affected by the shortage. A communication letter has been sent to oncologists/hematologists to notify them of the shortage. Action plan approved by P&T Committee. Prescribers are encouraged to use alternatives where possible. Pharmacy is utilizing premix bags to draw up into syringes to conserve current stock. If stock reaches less than 1000 grams across the system, restrictions to the following patient groups will be implemented: a. Use in kidney transplant recipients (limit of 12.5 grams per case) and liver transplant cases (limit of 25 grams per case) b. Use in craniotomy procedures c. Patients with severely elevated intracranial pressure with neurologic injuries, where concentrated sodium chloride is not an alternative Limited to no stock in the system. The neurosurgery group has been notified of the shortage.

4 Nitroglycerin Vials and Drips Perflutren lipid microspheres Phosphate injections Prochlorperazine inj Propofol inj Protamine Inj Rabies Vaccine delays and the companies cannot estimate a release date. delays and another manufacturer voluntarily suspending production. The expected duration of the shortage is Both sodium phosphate and potassium phosphate injections are short. No known resolution date. The shortage is due to the sole supplier of the product temporarily suspending production and distribution of all drug products in November of 2011 Propofol is currently a critical shortage due to manufacturing issues, recall, and discontinuation by one manufacturer. The expected duration of the shortage is by the sole manufacturer. The product is currently on allocation, with no estimated duration of the shortage. No products are fully available. RabAvert available but there is a delay in getting orders as the company fulfills current orders. Shortage plan approved Dec P&T. For non-acs patients, encourage IV Nicardipine, IV Sodium Nitroprusside In cath lab, utilizing alternatives for IC use (verapamil or nicardipine) Plan approved at August P&T to allow for non-formulary use of Optison during shortage. Plan implemented on August 3, 2012 due to no stock of Definity in the system. Memo created for Definity and sent to pharmacy/echo techs-cardiology. Shortage plan in place. Limit amounts in TPN. For boluses, automatic interchanges to PO are in place if patient meets specific criteria. See shortage plan for further details. Stock is depleted. Alternatives should be used by prescribers (see memo on Methodist MD). There is a CPOE order alert for this shortage. Dispense on demand. Continues to be short. Procurement from PharMedium has occurred for OR use (pre-drawn syringes). Vials removed from Omnicell. CPOE alert is active encouraging alternative therapy in mechanically ventilated patients. An emergency use supply may be drop shipped. All physicians should be aware of this critical shortage. distributed to pharmacy staff on how to obtain: Novartis: a. Pre-exposure- representative said look at CDC website ( b. Post-exposure- will allow distribution via their customer service ( ) or local distributor. Sanofi-Pasteur: a. Pre-exposure- None b. Post-exposure- will allow overnight distribution, physician must fill out form and fax to company ( es%20post%20exposure%20form%20revised%20final.pdf )

5 Sodium Bicarbonate Sodium thiosulfate inj Trace elements delays and increased demand for product. American Regent-temporarily d/c of manufacturing. American Regent-on backorder with no release date for the 100 mg/ml 10 ml vial presentation; American Regent and Hope Pharmaceutical have 250 mg/ml 50 ml vial available. Shortage is due to the sole manufacturer having manufacturing problems. FDA has approved temporary importation of sodium bicarbonate 8.4% injection from Australia will take to P&T for approval to order this product if needed. P&T approved emergency auto interchange from sodium bicarbonate to normal saline when ordered from the RCN prophylaxis protocol (implemented Monday 3/26). EH cart par reduced from 2 to 1; Broselow cart par reduce from 3 to 1 on adult presentation and from 4 to 2 on pediatric presentation. Reduce in cardiac boxes from 6 to 4. CPOE alert: critical national shortage, order alternative therapy whenever clinically possible; memo on Methodist MD. Pharmacist to call prescriber on all new orders to ask for an alternative. There is severely limited stock within the entire system and we will probably exhaust our supply at current usage. A minimal supply must be kept in reserve for emergent known cyanide toxicity situations. During the shortage of sodium thiosulfate, nitroprusside infusions will be sent without any sodium thiosulfate added. Pharmacy is notified when a nitroprusside infusion stays on a patient s profile for greater than 48 hours. Conservation plan is in place. Patients on long-term TPN will receive trace elements on MWF. Please see plan for further details. Reference: ASHP s national current drug shortages list. Accessed February Recently removed from list: Dopamine, Potassium Chloride, Etomidate, Dexamethasone, Meropenem, Bumetanide Where is information on drug shortages posted? On MOLLI>>drug information>>drug shortages This includes a full report of all national shortages and the above abbreviated report

6 On Methodist MD>>Quality and Patient Safety>>Pharmacy and Therapeutics>>Drug Shortages and on Methodist MD under recent news This includes a full report of all national shortages and the above abbreviated report, and specific memos (e.g. propofol, sodium bicarbonate). Updated/new memos are posted under recent news. On System Pharmacy Sharepoint Page>> Shared documents>>drug shortages This includes the Excel tracking log used by the pharmacy drug shortage team of all shortages critical to Methodist. This also includes specific drug shortage memos