Outpatient Surgery Magazine

Year of the Nurse - November 2020 - Subscribe to Outpatient Surgery Magazine

Outpatient Surgery Magazine, providing current information on Surgical Services, Surgical Facility Administration, Outpatient Surgery News and Trends, OR Excellence and more.

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line options in the event there's a shortage of the medication of choice. Maintain standard order sets (SOS) for your workhorse medications as well as for your facility's secondary and tertiary choices. The order sets are critical clinical tools that have dosage recommendations on them. Many medica- tion errors occur when providers make dosing errors with medications they're not used to adminis- tering. If a large orthopedic center typically uses morphine, but pivots to hydromorphone because of a morphine shortage, the dosage is less because the substitute is more powerful. If fentanyl is used as a replacement, it's even more potent, so the dosage is smaller still. These backup medications aren't unsafe. You just have to follow the dosage noted in the SOS so errors don't occur. Be flexible If a medication in the form you generally administer it is in shortage, check to see if oral forms are more easily obtained. It's always more convenient to hang a 50 ml mini-bag of medica- tion, but if you don't have it or it costs a premium to get, find out if that drug can be given by IV push over a three- to five-minute period. Know how to properly dilute the medication and, if it's drawn into a syringe, make sure you have labels on hand to properly identify the contents of the syringes. Commercially available prefilled syringes are often a good, albeit expensive, alternative dur- ing shortages. Consider workarounds If you work with a 503B compounding phar- macy, find out if they can compound medications on shortage from active pharmaceutical ingredients, a practice the FDA allows during shortages. Even if you don't currently use a compounding pharmacy, you should establish a relationship with one who can compound from active pharmaceutical ingredi- ents during a shortage. The same principle applies to surgery centers that are part of larger hospital systems. If you work in a hospital-owned facility, communicate with the hospital's pharmacy about pending shortages and determine what their com- pounding capabilities are, and what medications might be available from them in prefilled syringes. Also, look into contracting directly with pharma- ceutical companies, especially for your workhorse medications. Even if you generally obtain medica- tions through wholesalers and distributors, direct contracts should be considered in this era during which shortages are the norm, because pharmaceu- tical companies can sometimes offer emergency allotments of medications that are on shortage. Communicate clearly During daily staff huddles, mention what drugs are on or might go on shortage. Also ask your medication supply representatives about what drugs that are anticipated to go on shortage. You may want to have more of these medications on hand, but don't engage in stockpiling or buying alternative agents. Include surgeons in conversa- tions about shortages as well. Just as there might be a shortage of one medication in the Midwest while it's abundant and available on the West Coast, the same could be true locally. A surgeon could arrive at your facility on Tuesday to learn that there's no fentanyl, while the large academic medical center with larger inventory stocks he was at the day before had it. Surgeons don't like inconsistencies or surprises, so keep them in the loop about shortages and your current medication inventories. Maintaining open lines of communication with all stakeholders can prevent finger-pointing when a shortage invariably takes place. Prepared to pivot The last thing you want to do is postpone cases, but elective procedures should be rescheduled if you're unable to get the medications needed to provide safe patient care. An overall strategy of staying on top of pending shortages, keeping adequate invento- ries of your primary and replacement medications, and expanding relationships with suppliers, will keep your facility nimble enough to ensure cases remain on the schedule, regardless of when short- ages hit. OSM Dr. Vaida (avaida@ismp.org) is executive vice president at the Institute for Safe Medication Practices, a nonprofit education organization in Horsham, Pa. 5 4 3 N O V E M B E R 2 0 2 0 • O U T P A T I E N T S U R G E R Y . N E T • 7 7

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