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Contingency plan for 0.75% hyperbaric bupivacaine shortage: Ensuring maternal safety
Abstract Number: T2D-480
Abstract Type: Original Research
Drug shortages rose by 27% from 2017-18 in the United States, with resultant economic and patient safety implications. The Shortage of 0.75% hyperbaric bupivacaine (HB), the local anesthetic of choice for spinal anesthesia for cesarean delivery (CD) has significant implications in obstetric anesthesia. We would like to highlight steps in developing a contingency plan (CP) to mitigate this shortage.
Key steps (Appendix-1)
Created multidisciplinary chain of communication: pharmacy to providers
Consolidated remaining 0.75%HB stocks
Obstetric anesthesia team shared insights, experiences using alternative local anesthesia and reviewed literature of comparison to 0.75 %HB
CP Communicated to providers caring for CD patients:
Alternative drug choice of 1.4cc 0.75% plain bupivacaine+15micrograms fentanyl+150micrograms preservative free morphine; plain bupivacaine when used for CD can be unpredictable, thus we chose to administer it via a combined spinal epidural (CSE) technique, which takes longer than a spinal, thus less desirable for emergent CD resulting in parturients undergoing general anesthesia (GA). Thus, remaining stock of 0.75% HB was allocated for such cases to avoid GA.
CP reversed at resolution
Duration of shortage: 6 months
Remaining 0.75%HB 100vials
346 CD performed
87vials of 0.75%HB used
Quality data by providers showed no adverse patient events and unwarranted GAs for emergency CD.
Providers were familiarized with the alternative drug, dosing and method of administration to avoid medication errors.
Trainees Re-trained to perform CSE for CD with attention to spread but had reduced training in spinals for CD.
Dilemma of patients’ right to be informed on aspects of their care if morbidity and mortality is significantly increased with the alternative plan.
The key to navigating shortage was early communication between pharmacy and anesthesia, timely proposal of a CP, with goal of avoiding GA for CD due to selective allocation of remaining drug.
At national level, an early warning system to allow institutions to develop CP early, with restricted allocation of drugs by manufactures to minimize drug hoarding should be created.
(SOAP) Advisory in Response to Shortages 2018, ASHP Guidelines on Managing Drug Product Shortages in Hospitals and Health Systems. 2009