Outpatient Surgery Magazine

panies to produce the medications. Big Pharma is big businesses, first and foremost, and companies are opting to focus their manufacturing resources on more lucrative brand-name therapeutics. Mother Nature and market forces make drug shortages predictability unpredictable — and extremely difficult to manage. But try telling that to frustrated anesthesiologists and surgeons who don't give two shots of saline about the underlying causes that limit their access to needed medications. You can look for untapped resources (spoiler alert: none exist) to find the drugs they want or you can accept that managing drug shortages is the new normal and realize that doing it well demands a bit of clinical creativity, con- stant communication with your surgical team and plenty of hard work. 1. Monitor drug shortages daily. Start by being proactive, not reactive, when managing your facility's drug inventory. Review the live list of drug shortages that's posted on the website of the American Society of Health- System Pharmacists (ashp.org/shortages). The list should be your go-to resource. Check it every day and sign up to receive email alerts of new and resolved shortages. Dextrose is on it right now. Bupivacaine, too. And fentanyl and ketorolac. Obtaining various sizes of morphine and hydromorphone has also been problematic in recent months. 2. Stock up on drugs in shortage. If a drug you need is on shortage, scour the online inventories of your medication suppliers and immediately order available supplies, suggests Thomas Durick, MD, a consultant anesthesiol- ogist with Envision Physician Services in Walnut Creek, Calif. Dr. Durick, the former medical director of a busy multispecialty surgery cen- ter in the San Francisco Bay Area, recalls dropping a batch of medications into his online shopping cart and clicking to confirm the order — only to find the inventory he reserved seconds earlier had vanished. "The market is that volatile," he says. "If you put off ordering medications that are in short supply, even for a couple hours, you might come up empty." Comparing current shortages to your facility's inventory should sit atop your to- do list. As a consultant, Dr. Durick regularly visits 6 surgery centers and is sur- prised that even the largest and busiest one has only a single staff member who monitors drug shortages — on a part-time basis, no less. "You're at a severe disadvantage if you don't have a dedicated staff member in charge of constantly ensuring needed medications are on hand," he says. "Make sure the person understands the critical important of the job. If they don't, find someone else who does." Erin Fox, PharmD, BCPS, FASHP, senior director of drug information and support services at University of Utah Health Care in Salt Lake City, monitors the drug market and updates the list of shortages posted on the ASHP website. "Keep constant tabs on your own supply in order to determine how much product you have on hand and how long that supply will last," says Dr. Fox. "It's important to have a plan in place that you can implement when shortages occur." A U G U S T 2 0 1 9 • O U T PA T I E N T S U R G E R Y. N E T • 1 9 Pamela Bevelhymer, RN, BSN, CNOR

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