heparin shortage...again

[lisinopril]

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We have a shortage of heparin drip now. I am wondering how you guys handle this at your hospital. Do you mix the heparing 5,000 units inside the D5W/NS solution? If so, what is the stability duration after mixing? Please share...thanks.

 

[Sparda29]

I've been mixing 2 of the 10,000 unit/ml with 1 of the 5,000 unit/ml vials into D5W. We put a 24 hour expiration on it.

I don't get how this **** happens though. Honestly, if I was a DOP I'd make sure we had like a 1-2 year supply on hand of certain drugs. We just got the Magnesium 2 gram/50 mL sterile water in. If it was me, I'd order like 20,000 bags of the stuff, not ****ing 100 bags that we're gonna have to re-order.

 

[Praziquantel86]

So your hypothetical pharmacy with an unlimited budget also has limitless supply space?

 

[Sparda29]

So your hypothetical pharmacy with an unlimited budget also has limitless supply space?

We have like 2-3 big rooms that can be used for storage but we only use 1.

 

[Momus]

I've been mixing 2 of the 10,000 unit/ml with 1 of the 5,000 unit/ml vials into D5W. We put a 24 hour expiration on it.

I don't get how this **** happens though. Honestly, if I was a DOP I'd make sure we had like a 1-2 year supply on hand of certain drugs. We just got the Magnesium 2 gram/50 mL sterile water in. If it was me, I'd order like 20,000 bags of the stuff, not ****ing 100 bags that we're gonna have to re-order.

lol 20,000 bags. You can't have $1M worth of inventory/month when you only sell $200k/month, you could have invested 800k somewhere else (open more pharmacies, expand, hire more doctors, or more beds) and make more money, not just dead inventory wasting storage space and rent. You only stock drugs as fast as you can sell them. Run a pharmacy like you run a business. Walmart becomes the largest retailer because they have very strict control of their inventory and cut costs like crazy.

 

[Sparda29]

lol 20,000 bags. You can't have $1M worth of inventory/month when you only sell $200k/month, you could have invested 800k somewhere else (open more pharmacies, expand, hire more doctors, or more beds) and make more money, not just dead inventory wasting storage space and rent. You only stock drugs as fast as you can sell them. Run a pharmacy like you run a business. Walmart becomes the largest retailer because they have very strict control of their inventory and cut costs like crazy.

Okay, but this isn't just a small hospital. It's a hospital that's part of one of the largest health-systems.

 

[Ackj]

I don't get how this **** happens though. Honestly, if I was a DOP I'd make sure we had like a 1-2 year supply on hand of certain drugs. We just got the Magnesium 2 gram/50 mL sterile water in. If it was me, I'd order like 20,000 bags of the stuff, not ****ing 100 bags that we're gonna have to re-order

The mentality of "omg shortage! buy it all while you can!" just contributes to the shortage, because everybody overindulges. If every hospital regularly purchases and uses X units, and suddenly they all start purchasing Y units, the already limited supply is going to vanish, and some hospitals will be left empty handed.

lol 20,000 bags. You can't have $1M worth of inventory/month when you only sell $200k/month, you could have invested 800k somewhere else (open more pharmacies, expand, hire more doctors, or more beds) and make more money, not just dead inventory wasting storage space and rent. You only stock drugs as fast as you can sell them. Run a pharmacy like you run a business. Walmart becomes the largest retailer because they have very strict control of their inventory and cut costs like crazy.

Arguably, it could be a great investment to purchase all of the supply and resell it at inflated prices when the shortage hits. Was reading an article about shortages and the grey market a while back. Interesting topic.

 

[smercer]

Okay, but this isn't just a small hospital. It's a hospital that's part of one of the largest health-systems.

And? Just because your budget is X does not make sense to spend it all. Also realize that in most places bonuses are based off of the amount under budget the area is. Thus, spending all of your budget every year to have 3 months supply of every drug is not beneficial for the deptartment or you, as I assume you would rather cash a bonus and mix some extra drips than not.

Then realize that you will always have plenty of D5W around and should always have plenty of heparin vials (small item with extensive use), thus even in shortages you have an easy solution.

The real issue is when stuff that cannot be compounded goes into shortage, such as the recent D50 and Sodium Bicarb PFS shortages.

 

[Sparda29]

And? Just because your budget is X does not make sense to spend it all. Also realize that in most places bonuses are based off of the amount under budget the area is. Thus, spending all of your budget every year to have 3 months supply of every drug is not beneficial for the deptartment or you, as I assume you would rather cash a bonus and mix some extra drips than not.

Then realize that you will always have plenty of D5W around and should always have plenty of heparin vials (small item with extensive use), thus even in shortages you have an easy solution.

The real issue is when stuff that cannot be compounded goes into shortage, such as the recent D50 and Sodium Bicarb PFS shortages.

With the D50s, we've been ordering 1000 mL D50 bags, drawing up 50 mLs into a syringe and sending up those syringes to the floors with 24 hr expiration.

 

[xiphoid2010]

With the D50s, we've been ordering 1000 mL D50 bags, drawing up 50 mLs into a syringe and sending up those syringes to the floors with 24 hr expiration.

I had a protocol approved to bolus 250ml of D10 in place of 1 amp of D50 except for crash carts and patients on strict fluid restriction.

And as others mentioned. It's generally a bad financial practice to maintain a large inventory, that's money tied up on the shelf. Where I used to work, the performance bonus is based on tiered cost savings.

 

[sakigt]

Compounding the bags like we did ~3 years ago when I first started. Although weve got a small supply coming in. Not enough to be comfortable with but...

Same with Dex syringes. We were making them by hand as well PRN. We switched to the bags as well...

 

[confettiflyer]

I've been mixing 2 of the 10,000 unit/ml with 1 of the 5,000 unit/ml vials into D5W. We put a 24 hour expiration on it.

I don't get how this **** happens though. Honestly, if I was a DOP I'd make sure we had like a 1-2 year supply on hand of certain drugs. We just got the Magnesium 2 gram/50 mL sterile water in. If it was me, I'd order like 20,000 bags of the stuff, not ****ing 100 bags that we're gonna have to re-order.

Dude, do you know nothing about inventory management? Stocking a year supply is...******ed.

Edit: you've already been schooled by the above posts, didn't mean to pile on.

 

[psychoandy]

is it just the med safety nerd in me, or does it seem wrong to mix 2 different concentrations of a high risk high alert medication in one bag? shouldn't you use either use 10,000/ml or 5,000/ml?

also lol on stocking a year's supply of heparin drips. being from NYC you should know physical space is at a premium. and of course CREAM...you can make heparin bags, but stuff you can't make is at a premium price point (like IV phos products)

 

[ucrx]

is it just the med safety nerd in me, or does it seem wrong to mix 2 different concentrations of a high risk high alert medication in one bag? shouldn't you use either use 10,000/ml or 5,000/ml?

That was the first thing I thought too.

 

[Sparda29]

is it just the med safety nerd in me, or does it seem wrong to mix 2 different concentrations of a high risk high alert medication in one bag? shouldn't you use either use 10,000/ml or 5,000/ml?

also lol on stocking a year's supply of heparin drips. being from NYC you should know physical space is at a premium. and of course CREAM...you can make heparin bags, but stuff you can't make is at a premium price point (like IV phos products)

Less waste, less vials?

 

[confettiflyer]

Less waste, less vials?

cost, benefit, and risk of compounding error....i'll take the waste, heparin is cheap, lawsuits are not.

risk management dude!

 

[Ackj]

Less waste, less vials?

Rather than do 2x10,000 +1x5,000 per bag, why not use 5x10,000 and make 2 bags? Seems to be less waste and less chance of errors.