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Drug Shortages Related to Infusion

If your hospice agency prescribes infusion for pain relief (PCA), this update is of extreme importance. The supply of several medications and IV saline bags has been limited/unavailable for some time. The devastating damage caused by Hurricane Maria, in Puerto Rico, completely destroyed some of the major manufacturing sites. Manufacturers have not been able to replenish stock to keep up with the demand. All injectable narcotics are in short supply, although we do have some inventory to fulfill orders. The following are currently in limited supply or unavailable from our wholesaler. The anticipated date of recovery is also provided.

  • Morphine is out of stock from our wholesaler. ACP has limited supply of morphine. Recovery is expected in September, 2018, although some product may be available sooner.
  • Hydromorphone is out of stock from our wholesaler. ACP has a moderate amount of hydromorphone. Recovery is expected in late June, 2018.
  • Fentanyl is in limited supply from our wholesaler. ACP has a moderate amount of fentanyl.
  • 0.9% sodium chloride (NS) 100ml bags are out of stock. ACP has no supply. We have been preparing bags to assist with this shortage. Unfortunately, 100ml empty bags are now unavailable. Recovery date is unknown.

We have come up with some solutions to resolve these problems with short supply. When considering infusions for pain control (PCA), please remember the following:

  • 1. Always call the pharmacy first, to determine which injectable narcotic pain medications are available. Don’t be surprised if this changes on a weekly basis. ACP has no control over manufacturer suppl
  • 2. If the patient is able to take oral medications, use oral medications. This will avoid further depletion of the low supply of injectable narcotics. Also, it is much more cost-effective for hospice.
  • 3If oral route is not appropriate, consider intermittent injections. Many hospices use SQ button or IV push for “as needed” (prn) orders. It may be possible to prefill syringes if single dose vials are unavailable. Again, please call the pharmacy to see what is available and how we can best help the patient.
  • 4. ACP pharmacists are trained to assist with equianalgesic dosing conversions, if the drug requested is not available. Please call to discuss appropriate options.
  • 5. ACP usually dispenses 100ml bag sizes for PCA use. Since 100ml bags will be depleted within the next one to two months, bags will increase to 250ml volume. Sometimes this may be more medication than the patient will use before they pass away or bags may expire before they are completely used. We may consider removing volume from a 250ml bag to prepare a 200ml bag, if that is more applicable for the patient.

We apologize for the inconvenience that this temporary shortage causes to your hospice. Please be patient while we do the best we can to accommodate your needs and explore other options for appropriate pain control. The solutions we have presented are a proactive means to avoid frustration and dissatisfaction with the system. Thank you for your understanding.