from KRON-TV – April 24, 2020
We’ve been hearing about shortages on personal protective equipment or PPE and ventilators.
Pharmacists are now sounding the alarm on a possible shortage of ventilator drugs.
While California has been spared on a ventilator shortage, there is still great concern about the medication supply that relates to ventilators.
A nurse says, just weeks ago, San Francisco General Hospital experienced a shortage on a type of sedatives.
“The typical drugs that they would use were very low,” Jennifer Esteen said.
Jennifer Esteen is a psychiatric nurse at San Francisco General Hospital and vice president of the Nurses’ Union SEIU 1021.
She says the hospital experienced a challenge with ventilator sedatives.
“They had to figure out how to improvise and make new medications that could still serve the function of paralytics,” Esteen said. “They had to use a substitute basically.”
When a patient has to be intubated, a tube is inserted through the mouth and then into the airway to assist with breathing.
“They have to be paralyzed because there’s such powerful reflexes like coughing and things like that,” Dr. Michael Gropper said. “The patients are sedated, they’re not aware that we’re doing this but that medication is very important.”
Dr. Michael Gropper is a professor and chair department of anesthesia and perioperative care at UCSF.
He says while UCSF Medical Center has enough ventilators for patients, the supply for sedatives are low and can impact not just COVID-19 patients but those in intensive care units and operating rooms.
“We have about a two week supply of those paralytic medications,” Dr. Gropper said. “Given our current usage, and our current usage is quite low because we cancelled all elective surgeries and even some semi urgent surgeries so we’re quite concerned about that as well.”
“I think there’s been less discussion about the medications needed in order to maintain patients on ventilators,” Samantha Bastow, PharmD, said.
Bastow is a pharmacy solution advisor at Lumere, which helps hospitals solve healthcare supply chain challenges.
“One strategy that’s been really helpful for many hospitals is being proactive and creating alternative treatment protocols for ventilated patients,” she said. “So not waiting until drug supply gets really low at their hospital but instead saying what does plan B look like if we have to start using medications that perhaps we’re not used to using as frequently.”
Dr. Gropper at UCSF says using alternative drugs can be difficult to use and still looking for other options.
“We don’t have many alternatives and much as we didn’t have a big supply of ventilators and masks and gloves, there’s not a big central stock pile of these medications and that’s something that has to change,” Dr. Gropper said.
“It’s really frightening to imagine that our public heath system and our safety net hospital institution doesn’t have the adequate medication supply that’s needed,” Esteen said.
Bastow says there’s a nationwide shortage on sedatives, pain medications and neuromuscular blockers. While some hospitals have been impacted more than others, stockpiling medications can make the shortage worse.
“We understand why hospitals do this they want to get as much medication as they can so that they don’t run the risk of running out to be able to treat their patients,” Bastow said. “However, when they do this, when they stockpile it, it really hurts other hospital’s ability to obtain that drug for their patients.”
In the next potential shortage that hospitals have their eyes on – staff.
Many healthcare workers from the Bay Area are traveling to New York to help with the COVID-19 crisis there and that means less front line workers here.