Management of a parenteral opioid shortage using ASHP guidelines

Area of Science:

• Healthcare Management
• Pharmacology
• Patient Safety

Background:

• Hospitals faced significant parenteral opioid shortages in early 2018.
• The American Society of Health-System Pharmacists (ASHP) provided guidelines for managing drug shortages.

Purpose of the Study:

• To describe the application of ASHP guidelines in managing a parenteral opioid shortage.
• To evaluate the impact of implemented strategies on opioid dispensing.

Main Methods:

• Daily dispensing reports from automated cabinets and electronic health records were analyzed.
• Opioid data were converted to morphine milligram equivalents (MME) for inventory and consumption assessment.
• Strategies included utilizing substitute opioid therapies and altering administration methods (e.g., PCA to bolus).

Main Results:

• Parenteral opioid supplies were rationed, preventing cancellation or delay of surgical procedures.
• Inpatient opioid dispensing decreased from 2.0 to 1.4 million MME.
• Operating room opioid dispensing decreased from 0.56 to 0.29 million MME.
• Patient-controlled analgesia (PCA) use declined by 67%, and opioid infusions by 65%.

Conclusions:

• A multidisciplinary approach is crucial for managing drug shortages effectively.
• Implementing strategies like clinician notifications and identifying alternative therapies is essential.
• The hospital successfully navigated the opioid shortage without compromising patient care or procedural schedules.