STATUS



|X |

|Shortage |MEDICATION |THERAPEUTIC CLASS |SUBSTITUTION RECOMMENDATIONS |INVENTORY CHANGES |

|STATUS | | | | |

|Red |Morphine 4mg/ml 1 ml |Opioid analgesic |First alternative is ORAL whenever PO is possible. If IV Push needed for NPO or breakthrough | |

| | | |pain use hydromorphone IV. | |

| | | | | |

| | | |**AUTOMATIC Pharmacy Dose Limitation** | |

| | | |Pharmacy will implement a 3x dose limit for IV PRN morphine/hydromorphone orders in patients | |

| | | |able to take PO and has PO narcotic ordered. (excludes intubated patients) | |

| | | | | |

| | | |Refer to "Acute Pain Management Algorithm" for guidance in selecting equivalent PO regimens. | |

| | | | | |

| | | |Pharmacy will substitute IV Push morphine/hydromorphone orders from the ACUTE PAIN ALGORITHM | |

| | | |POWERPLAN with agents of comparable potency. Please see this link for more details | |

|Red |Hydromorphone 2 mg/ml 1 ml vial |Opioid analgesic | | |

|Orange |Lorazepam 2mg/2ml Inj |Sedative |ETOH patients on CIWA | |

| | | |First line oral lorazepam may be given orally or sublingually | |

| | | |Reserve Lorazepam IV PUSH for patients who are NPO or cannot receive sublingual dose | |

| | | |If lorazepam IVPush total= 20 mg within 6 hours, consider phenobarbital | |

|Yellow |Zosyn (all strengths) |Antibiotic |Please deescalating therapy to oral as soon as possible. For parenteral agent alternatives, | |

| | | |depend on IV Push abx, Ceftriaxone and Cefazolin if they can provide adequate coverage for the | |

| | | |infection | |

|Orange |Dorzolamide HCL 2% Opth 10ml (Trusopt) |Glacoma agent |Use patient's own medication | |

|Red |Dextrose 5% Water 100ml (Amiodarone |IVPB |**AUTOMATIC substitution and restriction** | |

| |150mg/ D5W 100ml) | |Amiodarone 150 mg/D5W 100 ml will be restricted to SICU use. Please see this link for more | |

| | | |details on substitutions. | |

| | | |Expected to last through 2017. | |

This critical drug shortage list is intended to keep SJMHS healthcare professionals apprised of the shortage status of the medications for the health-system. These shortages reflect national shortages. The pharmacy department will update the list at least weekly. Please make every effort to conserve the medications by following the clinical recommendations listed. Pharmacy Leadership Council approved all substitution recommendations. Any questions regarding the information should be directed to inpatient pharmacy management.

|Shortage |MEDICATION |THERAPEUTIC CLASS |SUBSTITUTION RECOMMENDATIONS |INVENTORY CHANGES |

|STATUS | | | | |

|Red |Diazepam 10mg/2ml carpuject |benzodiazepine |**Restrictions** Pharmacy will restrict IV diazepam to OR use and NPO/no |Pxyis: all unit stock will be removed except for OR. RN |

| | | |enteral access patients with muscle spasms. Shortage is expected to go through|must contact pharmacy for each dose. |

| | | |March 2018. | |

|Orange |Pantoprazole (Protonix) Inj |PPI |**Restrictions**Supply expected to be intermittent through January 2018 | |

| | | |Continuous infusion pantoprazole requires prior approval from GI. | |

| | | |Restrictions in place for IV push pantoprazole. | |

| | | |IV Pantoprazole restrictions | |

|Yellow |Sodium phosphorous Inj |Electrolyte |**AUTOMATIC SUBSTITUTION** Supply of IV Na phos is close to depletion. |Yellow |

| | | | | |

| | | |IV Phosphorous is restricted to serum PO4 less than 1.6 or NPO/no enteral | |

| | | |access | |

| | | |Pharmacy will automatically substitute with IV POTASSIUM Phos when K+ is less | |

| | | |than 4 mEq or CrCl is greater than 60 ml/min | |

| | | |The remaining IV SODIUM Phos is reserved for patients with K+ > 4 or CrCl < | |

| | | |60ml/min or fluid restricted. | |

| | | |Potassium phosphate IV is 2x volume of Sodium Phos IV. If replacement volume | |

| | | |for potassium phos is greater than 500ml pharmacy will page prescriber to ask | |

| | | |if patient is FLUID RESTRICTED. If yes, the patient will receive Sodium | |

| | | |Phosphorous IV. | |

| | | | | |

| | | |Expected to last June 2018 | |

|Orange |Sodium Bicarbonate syringes and vials |Electrolyte |**Restrictions**This is a national shortage and recall expected to last until |Pxyis: lower stock levels during this shortage and vials |

| | | |March 2018 |may be replaced with syringes |

| | | |During this time, lidocaine will not be buffered for IV line placement |Crash carts: Keep at 3. Do not remove until expired |

| | | |Reserved for severe metabolic acidosis. | |

| | | |Please refer to the | |

| | | |Sodium Bicarbonate Substitution Recommendations | |

|Orange |Bupivacaine 0.25% PF 10ml, 30ml |Anesthetic agent |When supply depleted substitute with 0.5% bupivacaine PF | |

|Orange |Bupivacaine 0.25% 30 ml PF vial |Anesthetic/OR use |Use what is in unit pxyis machine | |

| |Bupivacaine 0.25% w/ epi 1:200K 30ml PF| | | |

| |Bupivacaine 0.5% w/ epi 1:200K 30 ml PF| | | |

|Red |Dipyridamole Inj |Cardiovascular agent |Until December 2017. Lexiscan is approved for use during a shortage in Nuc Med | |

| | | |Pyxis | |

|Red |Fluorscein Strips |Ophthalmic agent | | |

|Orange |Atenolol tablets all strengths |Beta blocker |Nationwide shortage | |

|Orange |Gaviscon |Antacid |Substitute Maalox or simethicone. Resolution is expected until end of October | |

|Yellow |Dobutamine Injection |Inotrope | | |

|Yellow |D50W syringes and vials |Solution | |Crash carts: D50W syringes will be replaced if used or |

| | | | |expired. A sticker will inform user to call pharmacy if |

| | | | |more D50W is needed |

|Yellow |Vecuronium Inj |NMB |Use rocuronium whenever possible | |

|Yellow |Sinacalide (Kinevac) | |Please use as a multidose vial to preserve supply | |

|Shortage |MEDICATION |THERAPEUTIC CLASS |SUBSTITUTION RECOMMENDATIONS |INVENTORY CHANGES |

|STATUS | | | | |

|Yellow |Calcium chloride inj |Electrolyte |CRRT: covert to calcium gluconate bags. Pharmacy autosubstitution approved by Nephrology for |ALS boxes keep short dated products. |

| | | |CaCl(CaGluconate for CRRT |Crash carts: Keep at 2. Do not remove |

| | | | |until expired. |

|Red |Lidocaine 1% w/Epi 0.001% |Anesthetic/OR use |ONLY Available lidocaine alternative options are: | |

| | | |Lidocaine 0.5% w/epi 0.002% or Lidocaine 1.5% w/ Epi 0.001% | |

| | | |Some bupivicaine w/ epi strengths are also on shortage but 0.5% w/ Epi 1:200,000 is currently | |

| | | |available | |

| | | |DAILY users CONTACT your pharmacy representative with your department's alternative. | |

|Yellow |Atropine |Cardiovascular |October |Crash carts: keep at 2. Do not remove until|

| | | | |expired |

| |

|STATUS |TPN ADDITIVES |SUBSTITUTION RECOMMENDATIONS |STATUS |

|X |Zinc Sulfate |Replace with zinc chloride for all patients | |

| | | | | |

|STATUS |OR SOLUTION |SUBSTITUTION RECOMMENDATION |INVENTORY CHANGES |

|Orange |0.9 1L bottles |Use alternative size as available | |

|Orange |0.9 2 L bottles | | |

|Yellow |0.9 3L bags | | |

|Orange |0.9 4L bottles | | |

|Yellow |Glycine 1.5% 3L bags | | |

|Orange |Glycine 1.5% 4L Bottles | | |

|Orange |Sterile Water 2L bottles | | |

|Yellow |Sterile Water 3L bags | | |

|Orange |Physiolyte irrigation |Use 0.9% NaCl 1000ml if unavailible | |

|Orange |Normosol R |Plasmalyte-A 7.4 | |

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