Drug Shortages Increasing in the ED

July 18, 2017

Renee Petzel Gimbar, PharmD, is a clinical pharmacist of emergency medicine and medical toxicology at the University of Illinois Hospital & Health Sciences System. She’s been an emergency department (ED) pharmacist for almost 12 years and has launched emergency medicine clinical pharmacy services at 2 large academic medical centers.

She’s also had firsthand experience dealing with the explosion of drug shortages over the last decade and now shares her insights into how to read and react when emergency medications are in short supply.

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She also discusses the growing use of synthetic illicit drugs and the challenges ED caregivers face when attempting to reverse overdoses in drug abusers who show up for life-saving care.

What role do ED pharmacists play in monitoring drug supplies and helping to adjust to drug shortages?

I work very closely with our health system’s main pharmacy and the groups that control medication inventories. If they get notification that an agent will go on shortage, they do a good job of notifying me in the ED, talking through alternative therapies and discussing practical ways to restrict use of the drug.

It’s important to make sure providers in the ED are aware of shortages and know how to adjust to the short supply. The pharmacy sends emails to notify providers and pop-up alerts are added to the health system’s electronic medical record, but I’m also in the ED every day and talk to providers so they’re aware in real time of what’s going on with medication supplies.

How can ED pharmacists promote the safe and effective use of opioids?

The current epidemic is not surprising to many of us in health care. We’ve seen it coming for a long time. Although the majority of opioid prescriptions are not written in the ED — we’re not taking care of patients over the long term — physicians, nurses, and pharmacists in the department have a shared responsibility to ensure opioids are used appropriately and judiciously.

I alert providers when alternative therapies are appropriate and when opioids aren’t necessarily the medication a patient needs. ED pharmacists can also adjust default prescriptions for opioids to limit the supply to 3 to 5 days or extend the time between doses.

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