Drug shortages in anesthesia and perioperative medicine: Canada needs a better supply system (original) (raw)
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Factors associated with drug shortages in Canada: a retrospective cohort study
CMAJ Open, 2020
S hortages of EpiPen for severe allergies, 1-3 opioid drugs 4-6 and bupropion for mental illnesses 7 have recently made headlines in Canada and globally. Such shortages can have severe, even life-threatening, consequences for patients. 8 For example, shortages in generic intravenous norepinephrine are associated with increased mortality among patients with septic shock. 9 Opioid shortages increase the risk for medication errors (e.g., delayed time to analgesia, adverse effects) when patients are administered a less familiar alternative, which leads to unnecessary patient suffering and longer hospital stays. 4,10 In addition, drug shortages can aggravate the stress and burden on physicians and pharmacists and increase labour costs when they have to change their practices because of drug shortages. 8,10 Empirical studies of the causes of drug shortages have tended to use the longitudinal, high-quality drug shortage data provided by the US Food and Drug Administration 11 and American Society of Health-System Pharmacists. 12 These studies have identified manufacturing-quality problems for sterile injectable drugs, 13,14 declines in the number of suppliers for sterile injectable drugs 14 and lower drug prices for vaccine and generic drugs 15-17 as reasons for shortages in the United States. Empirical evidence from Canada is sparse because of a lack of reliable data on drug shortages. 18-21 Although Canadian drug manufacturers have voluntarily reported shortage data since 2011, these data were incomplete and unreliable for
Drug shortages in Canadian anesthesia: a national survey
Canadian Journal of Anesthesia/Journal canadien d'anesthésie, 2013
Background Canadian physicians are faced with an increasing frequency of drug shortages. We hypothesized that drug shortages have a clinical impact on anesthesia care in Canada. Methods We conducted a self-administered survey of anesthesiologists in Canada using the membership list of the Canadian Anesthesiologists' Society. For survey development, we identified key domains, including types of drug shortages, impact on the ability of anesthesia practitioners to provide general anesthesia care, and impact on patient outcomes. We undertook assessments of face validity, clinical sensibility, and content validity. Respondents were surveyed from January-April 2012. Results Completed valid questionnaires were submitted by 1,187 respondents (61.4%), and 779 (65.7%) of respondents described a shortage of one or more anesthesia or critical care drugs. Changes in anesthesia practice resulting from drug shortages were common; 586 (49%) respondents thought they had given an inferior anesthetic, and 361 (30%) reported administering medications with which they were unfamiliar. Respondents also reported that drug shortages were, at times, responsible for changes in the conduct of patient care, with 28 (2.4%) noting cancellation or postponement of surgery and 92 (7.8%) witnessing a drug error. One hundred sixty-five (13.9%) respondents regarded drug shortages as having prolonged recovery from anesthesia, and 124 (10.5%) viewed drug shortages as resulting in an increased number of postoperative complications, such as postoperative nausea and vomiting. Interpretation Drug shortages are common in anesthetic practice in Canada. This state of affairs may have a negative effect on how anesthesiologists practice anesthesia and may be associated with adverse patient outcomes.
The Canadian Journal of Hospital Pharmacy
Background: Drug shortages represent a complex global problem affecting patients and health care professionals on a daily basis. Objectives: To identify, describe, and compare drug shortages in health care facilities in Canada and 4 European countries in early 2018. Methods: A descriptive cross-sectional study was conducted in 1 hospital in each of 5 countries: Canada, France, Belgium, Spain, and Switzerland. Over a 4-week period, shortage data were collected daily by each hospital using a standardized grid and a standard process. Results: From January 8 to February 2, 2018, there were a total of 84 shortages (median duration 32 days) in the Canadian hospital, 62 shortages (median duration 9 days) in the French hospital, 46 shortages (median duration 37 days) in the Belgian hospital, 28 shortages (median duration 25 days) in the Spanish hospital, and 98 shortages (median duration 68 days) in the Swiss hospital. The number of manufacturers implicated in the shortages was 28 for the Canadian hospital, 30 for the French hospital, 19 for the Belgian hospital, 16 for the Spanish hospital, and 42 for the Swiss hospital. Most of the shortages involved parenteral drugs, with both innovative and generic manufacturers being affected. Most therapeutic classes were affected by shortages to some extent, with the top 3 classes being anti-infective agents (accounting for 21.1% of shortages overall), central nervous system drugs (11.3%), and cardiovascular drugs (8.2%). Conclusions: Drug shortages occurred almost daily in all of the study hospitals. Across the 5 hospitals, the frequency of shortages varied by a factor of 3, which may imply similar variability at the national level. All stakeholders should work more diligently to prevent and manage drug shortages.
Adequacy of antidote stocking in British Columbia hospitals: the 2005 Antidote Stocking Study
CJEM, 2006
Inadequate hospital stocking and the unavailability of essential antidotes is a worldwide problem with potentially disastrous repercussions for poisoned patients. Research indicates minimal progress has been made in the resolution of this issue in both urban and rural hospitals. In response to this issue the British Columbia Drug and Poison Information Centre developed provincial antidote stocking guidelines in 2003. We sought to determine the compliance with antidote stocking in BC hospitals and any factors associated with inadequate supply. A 2-part survey, consisting of hospital demographics and antidote stocking information, was distributed in 2005 to all acute care hospital pharmacy directors in BC. The 32 antidotes examined (21 deemed essential) and the definitions of adequacy were based on the 2003 BC guidelines. Availability was reported as number of antidotes stocked per hospital and proportion of hospitals stocking each antidote. For secondary purposes, we assessed factors...
Drug Shortages: A Complex Health Care Crisis
Mayo Clinic Proceedings, 2014
National tracking of drug shortages began in 2001. However, a significant increase in the number of shortages began in late 2009, with numbers reaching what many have termed crisis level. The typical drug in short supply is a generic product administered by injection. Common classes of drugs affected by shortages include anesthesia medications, antibiotics, pain medications, nutrition and electrolyte products, and chemotherapy agents. The economic and clinical effects of drug shortages are significant. The financial effect of drug shortages is estimated to be hundreds of millions of dollars annually for health systems across the United States. Clinically, patients have been harmed by the lack of drugs or inferior alternatives, resulting in more than 15 documented deaths. Drug shortages occur for a variety of reasons. Generic injectable drugs are particularly susceptible to drug shortages because there are few manufacturers of these products and all manufacturers are running at full capacity. In addition, some manufacturers have had production problems, resulting in poor quality product. Although many suppliers are working to upgrade facilities and add additional manufacturing lines, these activities take time. A number of stakeholder organizations have been involved in meetings to further determine the causes and effects of drug shortages. A new law was enacted in July 2012 that granted the Food and Drug Administration additional tools to address the drug shortage crisis. The future of drug shortages is unknown, but there are hopeful indications that quality improvements and additional capacity may decrease the number of drug shortages in the years to come.