Managing Drug Supplies Effectively during COVID-19 Pandemic
Communicate, be aware of EUAs and create a policy
BY SAHELY MUKERJI | JUNE 2020
Complications surrounding drug shortages stemming from the COVID-19 pandemic continue to emerge.
Last month, the US Food & Drug Administration (FDA) issued an emergency use authorization (EUA) allowing the emergency use of Fresenius Propoven 2 percent (propofol 20 mg/ml) Emulsion 100 ml, an unapproved drug. Under the EUA, the drug can be used to maintain sedation via continuous infusion in patients older than 16 years of age who require mechanical ventilation in an intensive care unit setting during the COVID-19 pandemic.
“The propofol we traditionally use is 1 percent or 10 mg/ml,” says Sheldon Sones, president of Sheldon S. Sones and Associates of Newington, Connecticut, and a pharmacy consultant to ASCs. “The substituted product of concern is 2 percent or 20 mg/ml. Usual dose by volume has to be halved. While the 100 ml product does not make sense in the ASC, it is recommended that we take extra care in stocking propofol.”
In addition, wholesalers might unknowingly supply a Propoven product instead of Diprivan or generic propofol or, due to shortages going forward, might only have the resources to supply the Propoven, he says. “This is an ICU COVID intended product. It is important that we be mindful of this possible medical safety concern.”
Suppliers are supposed to lock out the 2 percent or 20 mg/ml dose for ASCs, says Gregory Tertes, consultant pharmacist and president of ASC Pharmacist Consultants Inc. in Oakland, California. “When ASCs look up the drug, it should not even show up in the search,” he says. “It should show up for hospitals only. But we do not know about computer systems. This information must be entered in all the big manufacturers’ and wholesalers’ systems. We do not know whether this information is programmed in, or maybe the person entering the information is not even aware of this at all. So, we can imagine it getting into a surgery center and causing problems.”
ASCs must be aware that this EUA is for ventilator-use COVID-19 patients only and be cognizant of this change when ordering the propofol, Tertes says. “When ordering a substitute medication, ASCs need to make sure that the information is carried further down the line from the per-son who is placing the order. Mark the boxes with the change in size/strength/concentration,” he says. “Email all anesthesiologists, surgeons and staff about the change. Post a note on your central communication board about the substitute medication. And, lastly, put a note at the point of use, whether it be the anesthesia cart, the medication drawer or wherever the medication will be pulled out of.”
Drug shortages cascade into potential problems as the example above demonstrates. “Additionally, we may have to clarify or revise pre-printed or electronic anesthesia records to reflect the actual product being used should this product find its way into your facility, as remote a possibility as it is.”
Medication error prevention is all done in advance, Tertes says. To prevent such errors, “have a list of all the drugs that you need that are on shortage,” he recommends. “Check for them on a very regular basis, at least weekly if not more often. Make sure that you communicate with your provider what medication is on shortage—so they use it only when needed—and when bringing in a replacement.”