TN Experiences Ongoing Drug Shortages

FJ Thomas

Knoxville, TN ( – Some hospitals in east Tennessee have recently sent out notification to providers that medicine shortages now also include Patient-Controlled Analgesia (PCA) Pumps. While facilities have managed to deal with other drug shortages and find alternatives, this shortage in particular will pose incredible difficulties, as running out is inevitable.

According to WebMD, “…Patient-controlled analgesia (PCA) is a method of pain control that gives patients the power to control their pain. In PCA, a computerized pump called the patient-controlled analgesia pump, which contains a syringe of pain medication as prescribed by a doctor, is connected directly to a patient’s intravenous (IV) line.”

The manufacturer allotted 20 percent of their monthly supply to Parkwest Hospital in Knoxville, with the expectation that it would last the rest of the quarter.

According to L. Matthew Pittman, MD Chairman of Pharmacy and Therapeutics Committee for Parkwest: “We are only allowing a single cartridge per PCA ordered, then trying to use that to better understand the patient’s opioid use over a short period of time. This will allow us to calculate safe infusion recommendations with a PRN (as needed) dosage, a scheduled PO opioid with IV PRN dose, or recommend a PRN nursing administration dosage by itself. Despite these efforts, however we are still going to run out.” Pittman goes on to say that at this time there is no foreseeable end as they have no timetable for the shortage.

In June, the FDA issued a statement by Douglas Throckmorton, MD, Deputy Center Director for Regulatory Programs at the FDA’s Center for Drug Evaluation and Research, in response to the drug shortages. Manufacturing issues and hurricanes were the two main causes cited for the ongoing drug shortages.

According to the FDA, in some cases they have enlisted companies who make the same products to meet supply. Other manufacturers that are working with the FDA to increase production include Akorn Pharmaceuticals, Fresenius Kabi USA and West-Ward Pharmaceuticals. However, it will take time to work to meet that supply.

In the case of injectable opioids in particular, the FDA cited changes and delays at the Kansas Pfizer facility, in addition to issues with quality. The FDA also stated that Pfizer expects shortages and delays into 2019 but they are working with them “to release some of the products that were on hold due to potential quality issues to distribute them with instructions for the safe handling and use to help mitigate any risks to patients.”

So what foreseeable impacts could this have on work comp?

Total costs of drug expenses may be affected. According to MyMatrixx, an Express Scripts company, their reporting shows an 11.9 percent decrease for overall opioid costs in 2017 when the shortages began.

Impact on patient care and recovery may be another area that could see side effects of the drug shortages as substitutes are utilized.

According to the American College of Surgeons, although there are no official reports of IV bag complications related to shortages, there have been individual cases reported of complications from substitutions due to shortages.

Another area that could potentially be impacted, especially by the IV drug and PCA pumps shortages, is scheduling for surgeries. In the event that hospitals and facilities are rationing their supplies, it is possible that surgeries may be limited as a result.

Check back to for more coverage on this topic, and the effects it could have on work comp.

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