Outpatient Surgery Magazine

3. Stretch your current supply. Make the most of med- ications by investing in prefilled syringes, which limit waste, or split single vials into multiple doses. Keep in mind, however, that vials labeled by the manufacturer as "single dose" or "single use" should only be used for a single patient. And you can't draw up medication from multi-dose vials in patient treatment areas (the OR, procedure room or patient bedside). You must draw them up in a room remote from the procedure room using sterile technique. Members of your surgical team might have to alter their preferred practices and find creative ways to achieve desired outcomes. Dr. Durick, for example, recalls when hyperbaric bupivacaine was on backorder at his facility, and he struggled to find a viable alternative for administering spinal anesthe- sia. Dr. Durick, who generally prefers to place ultra- sound-guided regional blocks, combined an adduc- tor canal block and iPACK block with injections of Exparel (liposomal bupivacaine) around the inci- sion site during a medial unicompartmental knee replacement. "I provided the patient with longer-lasting pain relief with fewer risks and potential side effects," says Dr. Durick. "The short supply of bupivacaine forced me to find a better alternative." 4. Buy from multiple suppliers. Dr. Durick suggests diversifying your medication sup- ply options, especially if you work in a smaller sur- gery center, by working with 2 to 3 wholesalers. That way, you're not left in the lurch if one of the wholesalers decides to send limited supplies of in- demand medication to larger facilities with more purchasing power. You might also consid- er working with Civica Rx (civicarx.org), a fledging non-profit organ- ization in Lehi, Utah, that's partnering with pharmaceutical manufac- turers and healthcare facilities to ensure essen- tial generic medications in short supply are regu- larly available and afford- able. Civica Rx currently has relationships with manufacturers of van- comycin and dapto- mycin, and recently announced it will soon coordinate the produc- tion of 14 injectable med- ications (the specific agents were not announced by press time). Dr. Fox, who holds a volunteer position on the company's board of directors, says facilities pay a one-time membership fee (based on facility size) to the company and provide an estimate of how much of the available medications they'll need over a 5- year period. The facilities commit to purchasing the agents through Civica, which in turn ensures the medications will be available. It's a win-win arrange- ment that could help solve the shortage crisis; phar- maceutical manufacturers have guaranteed busi- ness for 5 years, and facilities receive a steady sup- ply of the medications they need. 5. Stock more often-used medications. If your facility employs just-in-time inventory man- agement, you probably keep a 3-day supply on shelves to limit waste and ensure drugs are used before they become outdated. That thinking makes good practical sense, but isn't the best way to man- age medications in short supply. "We've been burned by that before," says Tricia Meyer, PharmD, MS, FASHP, FTSHP, associate vice president in the department of pharmacy at Baylor 2 0 • O U T PA T I E N T S U R G E R Y M A G A Z I N E • A U G U S T 2 0 1 9 • NETWORKING OPPORTUNITY It's a good idea to develop strong working relationships with your medication supply reps, who can let you know if a batch of sought-after medica- tions is about to become available. Pamela Bevelhymer, RN, BSN, CNOR

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