To: Physician, Nursing and Pharmacy Staff From: Maryna Shayuk, MD, Chair, Pharmacy and Therapeutics Alan Mader, PharmD, Pharmacy Clinical Coordinator Date: 9/26/2018 Re: Sodium Bicarbonate Injection Shortage
Sodium Bicarbonate 8.4% Injection 50 mL is currently on shortage. There are different projections on how long this shortage will last, with some continuing until 2019. Sodium Bicarbonate is used for CODE BLUE situations and is available in Crash Carts. It is also used for Open Heart Surgery and for Toxicologic Emergencies.
The supply of Sodium Bicarbonate 8.4% Injection has not been stable for some time.
With uncertain supply, steps to maintain availability for Crash Cart Supply and for Open Heart Surgery need to be implemented.
Pharmacy will sequester supply to maintain stock for Crash Carts and for the surgical Open Heart room. When orders are received for sodium bicarbonate infusion, pharmacy will directly provide recommendation with the ordering physician to use sodium acetate injection. Information on the use of sodium acetate infusion is shown below:
Toxicologic Emergencies – Use Sodium Acetate 2 mEq/mL a. Bolus (if required) – 1 mEq/kg/D5W 500 mL infused over 20 minutes (consistent with information presented by ASHP). 150 mEq maximum to avoid osmolarity issues. For patients over 100 Kg, infuse over 30 minutes. b. Maintenance: Na Acetate 150 mEq/D5W 1000mL infused at 200 mL/hr for adult patients. 3 bag limit. The same rate would be used for urine alkalinization.
We are anticipating that the shortage will end before supply becomes depleted. If that is not the case, sodium acetate may also be used in Code situations as follows:
Crash Cart/Code situation – Requires dilution/infusion. 50 mEq Sodium Acetate added to 100 mL D5W (125mL TV) administered over 10 minutes
To: Physician, Nursing and Pharmacy Staff From: Alan Mader, Pharmacy Clinical Coordinator Date: 10/1/2018 Re: Sodium Phosphate Injection Shortage Potassium Phosphate Injection Shortage
Both Sodium Phosphate and Potassium Phosphate Injection are on shortage. Currently the system is in very low supply of Sodium Phosphate and pharmacy has transferred supply from the Huntley campus to the McHenry campus. The Sodium Phosphate shortage is projected to last 2 to 4 weeks. The Potassium Phosphate shortage is projected to last until late December.
These shortages have been newly announced.
Sodium Phosphate supply is very low within the system (17 vials). While Potassium Phosphate is currently in greater supply, projections indicate that it may remain on the shortage list an additional month longer that Sodium Phosphate.
Please conserve both Sodium and Potassium Phosphate Injection. Wherever possible, please consider oral replacement with Neutra Phos equivalent. Each packet contains: Sodium 160 mg (7.1 mEq), Potassium 280 mg (7.1 mEq), Phosphorus 250 mg (8 mMol).
Nursing and pharmacy will list patient allergies in the EMR. The severity of the allergy cannot be assessed by the nursing and pharmacy staff. Therefore the allergy severity will be listed as “unknown”. This will default to the presumed to be severe for the drug alerting.
Physicians can go and edit the severity based on history and clinical judgement.
Please edit the informant source to physician. This will allow the severity to flow from one admission to the next.
Potassium Chloride Injection Shortage – although product is still in short supply, Centegra pharmacies have been successful in obtaining supply. The manufacturer expects release on 8/23/18. At this time, we estimate we have at least a 4-week supply and can now begin using without restriction.
Please note that the CT Chest ILD protocol is specifically to evaluate for and differentiate between different types of interstitial lung diseases and includes expiratory phase and prone imaging. Usually this is on patients with known pulmonary fibrosis or longstanding shortness of breath. Also this is usually ordered by pulmonologists on outpatients. If a patient is acutely short of breath, has a lung nodule/mass, or in the hospital, usually a CT chest is the more appropriate order. This was previously named “High-Resolution Chest CT,” but the name was changed to better reflect it’s intended use. All of our CTs are high resolution.