FEATURE


change when ordering the propofol, Tertes says. “When ordering a substi- tute medication, ASCs need to make sure that the information is carried further down the line from the per- son who is placing the order. Mark the boxes with the change in size/strength/ concentration,” he says. “Email all anesthesiologists, surgeons and staff about the change. Post a note on your central communication board about the substitute medication. And, lastly, put a note at the point of use, whether it be the anesthesia cart, the medica- tion drawer or wherever the medica- tion will be pulled out of.”


Drug shortages cascade into poten- tial problems as the example above demonstrates. “Additionally, we may have to clarify or revise pre-printed or electronic anesthesia records to reflect the actual product being used should this product find its way into your facility, as remote a possibility as it is.”


Medication error prevention is all done in advance, Tertes says. To pre- vent such errors, “have a list of all the drugs that you need that are on short- age,” he recommends. “Check for them on a very regular basis, at least weekly if not more often. Make sure that you communicate with your provider what medication is on shortage—so they use it only when needed—and when bring- ing in a replacement.”


In addition, it is critical that ASCs


have updated policies and proce- dures in place, says Ernest P. Gates Jr., president and chief executive offi- cer of Gates Healthcare Associates Inc. in Middleton, Massachusetts. “Without a policy, your staff can’t be trained on how to handle another sim- ilar situation or acquire drugs in case of another such shortage. No matter what may happen in the pharmacy or the drug supply chain, the surgeon will ultimately be accountable.” Managing pharmaceutical sup- plies properly is more challenging during a period of drug shortages


If your staff does not have the capabilities to create and implement these policies and procedures, engage a consultant who can do this important work.”


—Ernest P. Gates Jr., Gates Healthcare Associates Inc.


than at any other time, he says. “In your policy, include a list of sources for getting your drugs. If you are purchasing compounded versions of commercially unavailable medica- tions, it is incumbent upon you to ensure that the medications are of the highest quality, and that there are no issues with the outsourcer you have chosen to purchase medications from.” The FDA publishes inspection results on its website, and it is impor- tant to review those before entering into a relationship with an outsourc- ing facility and as that relationship continues, he advises. Manufacturers, wholesalers/dis- tributors, 503B outsourcing facilities


and, in emergency cases, the laws allow 503A compounding pharma- cies to be a major source for drug shortage supply, Gates says. “Have some kind of a contractual agree- ment with your supplier.”


If you are stockpiling drugs, make sure to assign someone to manage it. “Someone who can keep track of expiration dates, extended use dates, changing labels in case of extended use or change in the size of a drug, proper disposal of unused drugs, and proper storage,” Gates says. “If your staff does not have the capabilities to create and implement these policies and procedures, engage a consultant who can do this important work.”


ASC FOCUS SEPTEMBER 2020 | ascfocus.org 17


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