Shortages

[pmichaelmd]

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Is anybody else as frustrated and concerned with the current shortages as I? We have recently run out of hydromorphone vials, are almost out of fentanyl, 0.5% bupivacaine, and prepackaged BD spinal trays.
I feel like we are MacGyvering stuff together on a daily basis. Anybody want to join me and import some goodies from across The Pond?
:/

Vent over.
PMMD

 

[Mman]

I actually want to open up my own manufacturing and pharmaceutical plant that can ramp up production and jack up prices when everybody else's go down. It's crazy how thin the supply chains on so much of this stuff are.

 

[Robotic Wis-Hipple]

The IV fluids one kills me. Like really?

 

[Mman]

The IV fluids one kills me. Like really?

you know that water + some electrolytes has to be so difficult to manufacture

 

[pmichaelmd]

With some inside assistance from various regulatory agencies, I smell a business opportunity here...

 

[pgg]

It's not that this stuff is hard to manufacture, it's that the profit margins are so thin most companies don't see a reason to bother. So very few do, and when one of them has a problem or quits, others still have little motivation to step in, and if they do, they still have all the regulatory overhead to get through before they can sell a product.

 

[powermd]

you know that water + some electrolytes has to be so difficult to manufacture

Supposedly it takes 3 weeks to make a batch of sterile saline. It's not as easy as you would think to ensure sterility on a massive scale. Much of this stuff is manufactured in Puerto Rico, where, as you know, power has been an issue.

 

[Noyac]

I’m waiting for the oxygen shortage.

 

[pmichaelmd]

I wonder how widespread the shortages truly are? My friends who are Anaesthetists across the pond don't report such shortages. Maybe it is at the discretion of the pharmacy departments and how aggressively they source?

 

[deleted162650]

I’m waiting for the oxygen shortage.

Don’t you already have one of those where you practice?

 

[Mman]

I wonder how widespread the shortages truly are? My friends who are Anaesthetists across the pond don't report such shortages. Maybe it is at the discretion of the pharmacy departments and how aggressively they source?

I'm sure it has to do with whatever sort of certification process there is to produce a medical device or drug for use on a patient in the US. We can't source from the same places they can so our shortages are not their shortages.

 

[Psai]

I like the part where people outside of hospitals are dying from too much opioids but people in hospitals can't find any.

 

[anbuitachi]

I like the part where people outside of hospitals are dying from too much opioids but people in hospitals can't find any.

theres a fentanyl and hydromorphone shortage?? I've only heard of the remifentanyl shortage

 

[d9sccr]

theres a fentanyl and hydromorphone shortage?? I've only heard of the remifentanyl shortage

Also IV morphine and methadone

We have <1 week supply

 

[pmichaelmd]

We are putting our heads together with our pharmacists to come up with workarounds. We have access to sufentanil and will likely start using that in small doses during cases instead of fentanyl and diluting it into bags for our epidural infusions. A pharmacist asked us about toradol infusions post-op...hadn't heard of that one and don't really think my group is considering it.

 

[Mman]

We are putting our heads together with our pharmacists to come up with workarounds. We have access to sufentanil and will likely start using that in small doses during cases instead of fentanyl and diluting it into bags for our epidural infusions. A pharmacist asked us about toradol infusions post-op...hadn't heard of that one and don't really think my group is considering it.

I've decided we should let the patients walk down the street and purchase their own opioids for use. I mean we let them take a "home med" in certain circumstances. Perhaps heroin should be allowed as a home med.

 

[pjl]

We are putting our heads together with our pharmacists to come up with workarounds. We have access to sufentanil and will likely start using that in small doses during cases instead of fentanyl and diluting it into bags for our epidural infusions. A pharmacist asked us about toradol infusions post-op...hadn't heard of that one and don't really think my group is considering it.

Preop orals. That takes care of a lot of the narcs. As stated elsewhere the orals aren’t on shortage.
Our hospital system has toyed with making its own dilaudid, have them do that.

 

[anbuitachi]

Try to get alfentanil?

 

[dhb]

We are putting our heads together with our pharmacists to come up with workarounds. We have access to sufentanil and will likely start using that in small doses during cases instead of fentanyl and diluting it into bags for our epidural infusions. A pharmacist asked us about toradol infusions post-op...hadn't heard of that one and don't really think my group is considering it.

Fast forward to 2018 and do some opiod free cases!

 

[pmichaelmd]

Certainly we do as much as we can without opioids, but it isn't practical to do a majority of cases without opioids at all, 2018 or not. We continue to cobble stuff together. Just answered the survey on the ASA website regarding this, maybe it will get better soon. It would be one thing if it was just opioids, but local anesthetics, IV fluids...seriously? Feel like I am in a MASH unit.

 

[Pooh & Annie]

Don’t forget ketamine. Now divided up in syringes by our pharmacy.
Although I always thought the 500mg vial was wasteful anyway.

 

[GlowInTheDark]

Blame Puerto Rico