Medication utilization in patients in New York hospitals during the COVID-19 pandemic

Abstract

Disclaimer In an effort to expedite the publication of articles related to the COVID-19 pandemic, AJHP is posting these manuscripts online as soon as possible after acceptance. Accepted manuscripts have been peer-reviewed and copyedited, but are posted online before technical formatting and author proofing. These manuscripts are not the final version of record and will be replaced with the final article (formatted per AJHP style and proofed by the authors) at a later time. Purpose Utilization of hydroxychloroquine, chloroquine, and supportive therapy drugs in hospitals in New York during the early weeks of the coronavirus disease 2019 (COVID-19) pandemic was analyzed. Summary Drug utilization trends for 7 medications used to treat patients with suspected or confirmed COVID-19 at 47 New York hospitals were identified. The data demonstrated sharp increases in aggregate utilization of hydroxychloroquine and chloroquine and the number of patients receiving either drug beginning on March 15, with a notable 20% median increase per day through March 31. The net quantity of drug charge units per day for midazolam, propofol, ketamine, cisatracurium, and fentanyl also increased during the study period. Following peak utilization, use of all study drugs decreased at different times throughout April 2020. The data were used to provide information to various stakeholders in the drug supply chain during the initial surge of the pandemic. Conclusion This analysis describes the increased use, beginning in mid-March 2020, of hydroxychloroquine, chloroquine, midazolam, propofol, ketamine, cisatracurium, and fentanyl in 47 hospitals in New York State. The increased utilization of supportive therapy drugs was consistent with the surge in patients with presumed or confirmed COVID-19 during the study period. These data and observations can help clinicians, health-system leaders, manufacturers, wholesalers, and policymakers understand the impact of current and future pandemics on the drug supply chain.

An examination of sedation requirements and practices for mechanically ventilated critically ill patients with COVID-19

“… 4 , 5 , 9 A study in New York hospitals found sharp increases in aggregate utilization of sedative and analgesic medications during the early weeks of the COVID-19 pandemic, consistent with the surge in patient numbers, but the study did not examine individual patient dosing. 10 Our study was the largest study to systematically quantify individual sedation and analgesic dosing requirements for mechanically ventilated, critically ill patients with COVID-19 that has been conducted to date (as of the time of writing). High analgesic and sedative medication requirements were observed in a multi-ICU cohort of mechanically ventilated, critically ill patients with COVID-19.…”

Incidence of adverse events for procedural sedation and analgesia for cardioversion using thiopental in elderly patients: a multicenter prospective observational study

“…Sedatives such as propofol, midazolam, and ketamine have been used in both mechanical ventilation management and PSA. These sedatives, particularly propofol, have been in serious short supply during the pandemic, 8 and might be prioritized for use in mechanical ventilation management. As such, propofol may not be available for PSA in some EDs.…”

“…Sedatives such as propofol, midazolam, and ketamine, which are frequently used in PSA, were in serious short supply. 8 …”

Preparing for the Next Pandemic

“…Although most shortages are a result of production interruption, surges in demand for specific drugs during a pandemic can also lead to inadequate supply. 4 In some cases, there were surges in treatments known to be effective in supportive care (eg, albuterol). In other cases, speculation about a drug’s effectiveness led to panic buying and therefore rapidly depleting inventory.…”