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Hospital supply shortage impacting patient care

Robin Wulffson MD's picture
drug shortage, IV fluids, nutrition drugs, sisinfectants, selenium

WASHINGTON, DC—A shortage of nutrition drugs and disinfectant problems has emerged in U.S. hospitals. Physicians have been forced to decrease dosages and ration supplies, resulting in a compromise of patient care. The shortage is a component of a more widespread deficiency of pharmaceuticals, which has attracted the attention of the Food and Drug Administration (FDA). On December 15, a Senate committee began considering legislation requiring companies to notify the FDA of problems that might result in a shortage so the agency can help prevent them.

Shortages of chemotherapy and anesthesia drugs have received much attention has recently attracted media attention; however, new research has found that nutrition medicines are among the categories hardest hit by short supplies. The shortages include vitamins, minerals, and liquid foods that go into intravenous fluids administered to patients who are unable to eat. These substances are delivered through an infusion pump into the body via a catheter implanted in a large vein, often in the chest.

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According to a Government Accountability Office (GAO) report released on December 15, the number of reported nutritional medicines running short rose to 13 in 2010, an increase from five in 2009. In 2010, among all drugs, the FDA estimated that 178 shortages occurred; to date for 2011, the total number has surpassed that.

The GAO notes that the primary cause for the shortages is production problems at factories. Industry consolidation has left fewer facilities to manufacture the drugs; therefore, when one falls behind, the rest of the system tries to catch up. For months, Texas Children's Hospital has been reducing calcium doses to some infants. Several months ago, children at St. Jude Children's Research Hospital in Memphis, Tennessee, were given gummy vitamins when the hospital could not obtain liquid multivitamin solutions. The substitute worked well for most patients; however, one child was hospitalized with a thiamine deficiency after being unable to tolerate the oral multivitamin. According to St. Jude's medication safety officer, many patients receiving organ transplantation at the facility are on nutrition supplements, known as parenteral nutrition, while they recover from surgery. The hospital also has experienced shortages of vitamins, amino acids, lipids or fats, and electrolytes (salts).

The University of Michigan's C.S. Mott Children's Hospital has a shortage of selenium, a trace mineral used as a supplement. The hospital recently stopped giving selenium to adult patients and some children, while reducing the dosage to others. American Regent is the only manufacturer of the mineral; the company is currently testing new equipment and expects to start shipping selenium again early next year. American Regent also manufactures a dehydrated alcohol product that is used to kill bacteria in tubes that go from a nutrition machine to a catheter inside the body. That product is also in short supply. Last April, American Regent shuttered a facility for several weeks to address manufacturing problems with other products and halted all shipments. The supply of dehydrated alcohol plummeted; however, it recently returned to normal. Because of the shutdown, for several months hospitals had only enough of the solution to clean patients' intravenous feeding lines twice a week rather than daily. Last summer, eight of nine pediatric patients at C.S. Mott Children's Hospital who were receiving parenteral nutrition developed infections.