Drug shortages in Canadian anesthesia: a national survey

Abstract

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. 123Can J Anesth/J Can Anesth (2013) 60:539-551 DOI 10.1007/s12630-013-9920-z Résumé Contexte Les me´decins canadiens font de plus en plus souvent face a`des pe´nuries de me´dicaments. Nous avons e´mis l'hypothe`se que les pe´nuries de me´dicaments avaient un impact sur les soins en anesthe´sie au Canada. Méthode Nous avons re´alise´un sondage auto-administreá upre`s des anesthe´siologistes au Canada en nous fondant sur la liste des membres de la Socie´te´canadienne des anesthe´siologistes. Lors de la mise au point du sondage, nous avons de´termine´des domaines cle´s, notamment les types de pe´nuries de me´dicaments, l'impact sur la capacite´des fournisseurs d'anesthe´sie a`offrir des soins d'anesthe´sie ge´ne´rale, et l'impact sur les devenirs des patients. Nous avons e´value´la validite´apparente, la sensibilite´clinique, et la validited u contenu. Les re´pondants ont reçu le sondage entre janvier et avril 2012. Résultats Au total, 1187 (61,4 %) re´pondants ont comple´ted es questionnaires de façon valable, et 779 (65,7 %) de ces re´pondants ont de´crit une pe´nurie d'un me´dicament ou plus utilise´en anesthe´sie ou en soins critiques. Les changements dans la pratique de l'anesthe´sie dus a`des pe´nuries de me´dicaments e´taient courants; 586 (49 %) re´...

Impact of Drug Shortages on Health System Pharmacies in the Southeastern United States

“…2 Shortages of critical drugs such as chemotherapy agents, analgesics, injectable nutritional supplements, anesthetics, anti-infectives, and Impact of Drug Shortages cardiovascular agents are common. [3][4][5][6] The primary causes for these shortages include inadequate raw materials, decreased number of manufacturers, and other factors that cause production to stall or be terminated. 7,8 Delayed or lack of communication among the FDA, manufacturers, and health care providers may contribute to the inadequate preparation in managing drug shortages.…”

“…Nearly half of them (49%) felt shortages were the impetus for the administration of inferior anesthetics. 6 Drug shortages often impact vulnerable populations including cancer patients or neonates, for whom few, if any, equivalent alternatives exist; shortages may result in clinical complications, as exemplified by selenium shortages. [10][11][12][13] Drug shortages may also force practitioners to prescribe infrequently used medications and concentrations, which can lead to medication errors as demonstrated with prior fentanyl shortages.…”

“…[10][11][12][13] Drug shortages may also force practitioners to prescribe infrequently used medications and concentrations, which can lead to medication errors as demonstrated with prior fentanyl shortages. 6 Drug shortages have also impacted life outside of patient care; for example, a planned execution in Oklahoma was delayed due to a drug shortage. 14 The financial impact of drug shortages in the United States is estimated at $99 million annually for acquisition costs alone.…”

Can we create a Canadian Perioperative Anesthesia Clinical Trials Group? We review the first five years and glimpse into the future

“…It has supported the Canadian Anesthesiologists' Society in its efforts to combat drug shortages 2 and the Canadian Journal of Anesthesia [2][3][4] in its promotion of the dissemination of high-quality research, and it has published original work in high-impact peerreviewed journals. 5 Members of the PACT have benefitted by being acknowledged as authors.…”

Drug shortages: Can we resolve that problem?

“…Les résultats du sondage national de Hall et coll., publiés dans ce numéro du Journal, mettent en lumière ce problème. 1 Cette augmentation des pénuries de médicaments est due en grande partie à la fermeture partielle imprévue de l'usine Sandoz (Boucherville, QC, Canada) au début du mois de février 2012 et des conséquences en aval d'une telle fermeture. Il serait facile d'accuser Sandoz de tous les problèmes découlant de leur décision mal planifiée, mais il existe de nombreux facteurs qui permettent d'expliquer pourquoi nous nous trouvons dans une situation si difficile aujourd'hui.…”