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.
All available flu vaccines are safe in all egg-allergic patients.
Sponsoring Organizations: American Academy of Allergy, Asthma, and Immunology (AAAAI); American College of Allergy, Asthma, and Immunology (ACAAI)
Target Audience: All providers who administer influenza vaccines
Historically, patients with egg allergy have been told to avoid flu vaccines, because most flu vaccines are produced in embryonated chicken eggs; the concern was that a vaccine might contain residual egg protein, which could lead to anaphylaxis. Many studies have shown that flu vaccines are safe for egg-allergic patients, but many physicians still have been hesitant to vaccinate such patients. This updated practice parameter incorporates recent data on flu vaccine safety in egg-allergic patients, including children.
Flu vaccines should be administered annually to patients with egg allergy of any severity, with no need to ask recipients about egg-allergy status and no special precautions beyond those recommended for administering any vaccine to any patient. This recommendation applies to both injected and intranasal formulations (although the latter should not be used in the 2017−2018 flu season).
Non−egg-containing vaccines can be used but are not necessary or preferred over standard vaccines.
The intranasal live attenuated flu vaccine also might be used, if it’s shown to be efficacious and is approved for use.
Egg-allergic patients can be vaccinated safely with any available age-appropriate flu vaccine, with no special precautions, regardless of egg-reaction history (including anaphylaxis). Concern for egg allergy only adds another barrier to universal flu vaccination, and this practice parameter concludes by stating the following: “Vaccine providers and screening questionnaires do not need to ask about the egg allergy status of recipients of influenza vaccine.”
Editor Disclosures at Time of Publication
Disclosures for David J. Amrol, MD at time of publication
There is a nationwide shortage on DOBUTamine 500 mg/250 mL IVPB. At present consumption, we expect CHS has about a 12 day supply. We may continue to receive backordered quantity, but we cannot rely on this. Please be aware of this shortage and consider alternatives as our supply depletes.
There is a nationwide shortage of morphine injection that expected to last until early to mid-November. The Pharmacy Department is running very low on supply and expects that the drug will become unavailable. Please consider ordering an alternate injection product for pain management. An opioid dose conversion chart is included below for your convenience.