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Area hospitals cope with national medication shortage

Caption
(Sarah Nader – snader@shawmedia.com)
Pharmacy technician Ann Bolton divides a 20-gram bag of magnesium into two-gram portions Friday while working at the central pharmacy at Centegra Health System's McHenry hospital. There has been an increase in drug shortages, especially of injectable drugs, since 2005.

As the national drug shortage continues, area hospitals are keeping a close eye on what they need and what’s available.

Almost 120 drugs are in short supply, according to the Food and Drug Administration. They include cancer drugs, anesthetics and electrolytes for patients on IV feeding.

“They’re not the exotic medications that are in the market,” said Centegra Health System’s director of pharmacy, Scott Padjen. “They’re the standard, common medications that most patients require when they come into the hospital.”

To make sure the hospitals have what they need, pharmacy staff have to “micromanage” the purchasing process more than they’ve needed to in past years, said Lanndon Rose, the director of ambulatory care and pharmacy services at Advocate Good Shepherd Hospital in ­Barrington.

Centegra Health System has hired extra technicians just to handle keeping up with the shortages on a day-to-day basis, Padjen said.

The extra work involves coordinating with other hospitals to see whether they have surpluses of any of the affected drugs, preparing some of the medication themselves, and working with doctors to see if and how the drugs can be rationed.

Propofol, for example, is an injection that has been in short supply since April, according to the Food and Drug Administration. Two of the suppliers listed increased demand as the reason behind the shortage.

The anaesthetic is used in surgeries and in the intensive care unit, Padjen said, but with the shortage, Centegra has had to limit its use, reserving it for surgeries.

Instead, Centegra is using alternatives, which work just as well, but patients can take longer to come out of the sedation, he said.

Alternatives also can be more expensive, a cost the hospitals carry.

Alternatives are costing Centegra an average of $8,000 a month, Padjen said. That figure doesn’t take into consideration the other cost impacts, including additional staff and hours devoted to managing shortages.

Advocate Good Shepherd Hospital doesn’t track the cost impact, Rose said, adding that the work it would be to track isn’t worth the effort.

“There’s not anything that we’re critically short of,” he said. “There’s things that we’re watching but nothing that we can’t provide.”

They have kept alternatives to a minimum through agreements with other hospitals – something Centegra does as well – and by loading up on certain drugs when they become available, Rose said.

Stockpiling can exasperate the situation, though, Padjen said. And it’s not just hospitals that are doing it.

Alternative suppliers, also known as “gray market” suppliers, also have been buying up drugs and then selling them to hospitals at a marked-up rate.

That’s something Padjen would like to see addressed.

Neither Padjen or Rose say they have the solution.

There are many theories floating around the industry, and the situation seemed to hit a peak last year, Padjen said. While it’s trailed off a little, he said, it’s still a major issue.

The FDA points to early notification, which it says has helped the agency prevent close to 100 shortages over a six-month period in 2012.

Rose is less optimistic.

“It’s not getting better,” he said. “I don’t know if it’s getting worse.”

About the shortage

In 2011, 251 drug shortages were reported to the Food and Drug Administration, up from 178 drug shortages in 2010.

A major reason for the shortages has been quality and manufacturing issues, according to the FDA. It also pointed to delays in receiving raw materials and components from suppliers.

Many of the drugs affected are sterile injectable drugs because any hiccup in the supply can cause a problem. Fewer firms make them and the complex manufacturing process makes increasing production difficult, according to the FDA.

For more information and to see a list of affected drugs, search for “drug shortages” at fda.gov.

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