Certain state surveyors ask centers to provide evidence that they are trying to acquire the replacement drug. “So, you cannot be asleep at the wheel,” he says. “You would have to show documented communication with your supplier/wholesaler—like emails or canceled orders—that shows you are trying to acquire the said extended use medication.”
Larger centers with multiple ORs might find it useful to create a list checklist that shows the extended use medications they have in stock and their location, Taylor says. “Ideally, you want those extended use medications to be used first. It’s basically triaging your supplies. The checklist would tell you where your extended use drugs are, so you are not searching for them under every leaf when you need them.”
When these extended use drugs become available in the market, try not to be over-reactive and hoard, Sones recommends. “Stay on top of your supply chain and work with two or more wholesalers. Learn about each supplier’s allocation policies and enlist your projected needs.”
Keep your staff informed, Taylor recommends. “ASCs often contract anesthesiologists,” he says. “You have to educate your contracted workers/end users of the extended-use drugs protocols you put in place in your ASC. Education and awareness are critical.”
To complete the circle, anytime you have your medication management or board of director meetings, document the extended use drugs situation in the minutes. “That keeps your medical staff informed,” Taylor says.
Drugs Not on the FDA List
“My main concern is propofol,” Sones says. “A high percentage of propofol comes from Italy, which has been severely hit by COVID-19. This drug will become problematic exacerbated by shrinkage from Italy. Equally of concern are cefazolin/i.e. Ancef, fentanyl, midazolam, epinephrine-containing products, dantrolene (Revonto made in Italy) and IV solutions.”
Review formulary options with your medical director, anesthesia lead and governing body, if one of the five drugs mentioned above disappears from the market, he says. “In the case of cefazolin, one drug for consideration is cefuroxime (Ceftin, Zinacef). Perhaps more costly, but it is a therapeutic option. Antibiotic use in most routine GI procedures continues to not be recommended by the American Society for Gastrointestinal Endoscopy.”
Should the fentanyl shortage evolve, consider less desirable opioids, i.e., meperidine. “Some compounders have begun to provide fentanyl product. Assure the vetting process should you engage a new compounder. Cost basis will be higher,” Sones says.