The other night while I was working in the emergency department, a particularly sick patient came into the ED. He was lethargic, had a high heart rate, and a very dangerous rhythm on his EKG –one that can quickly lead to collapse and death. I recognized that he had a dangerously high level of potassium, and called to the nurse to get the mainstay primary treatment for this–Calcium Gluconate. The nurse came back in fifteen seconds–“Doctor, the hospital has no calcium gluconate. There’s a shortage”.
Clearly, this patient’s heart did not recognize, or care about, whether we had a shortage. I needed to treat him, and I needed to treat him NOW.
This situation is becoming increasingly frequent in hospitals nationwide, with shortages of medications from cancer to emerency therapies.
Multiple reasons have been cited for the shortages, but the main drivers appear to be economic and regulatory. First, many of the drugs in shortage are generic, meaning that they draw much lower prices than their branded counterparts. As a result, pharmaceutical companies may drop production of these medications, in favor of a more lucrative one. Secondly, manufacturers of these medications are not currently required to alert ANYONE, including the FDA, when they stop making one of these medications permanently, nor when they have some production glitch that causes a temporary lapse in production. The result? We often do not realize until we have a shortage that the company stopped producing it several months ago. And by the time that you or your family member needs it, it’s too late.
A report in the American Journal of Health System Pharmacy estimated that the extra labor to work around these shortages adds $216M to the nation’s healthcare costs. In addition, forcing medical professionals to use medications with which they are less familiar increases the risk for medication errors, according to the Institute for Safe Medication Practices.
And my patient? The nurse was able to get a substitute medication, although we had to take the time to reformulate it to go into his IV. When the alternative medication was ready, we pushed that into his IV and…a breath of relief… his heart rhythm improved right in front of our eyes, there on the screen. In the ED, we’re accustomed to having to “Macgyver” solutions, as we never know what will come through that door. We are adept at finding solutions for our patients–regardless–and in time. Can Congress, the FDA and the pharmaceutical companies do the same?