A 35-year-old man was admitted to the intensive care unit (ICU) with a progressive skin and soft tissue infection of the arm after an injury from a do-it-yourself project at home.
The attending emergency department (ED) physician who initially evaluated and treated the patient, and the ICU team, identified the nature and extent of the infection and developed a plan to treat it with a specific antibiotic.
They ordered the medications and were informed by the hospital pharmacy that those drugs were on back order and unavailable. On the recommendation of the pharmacy and infectious disease specialists, doctors replaced the generally recognized standard therapy with a more expensive medication with several side effects. When the patient began to develop kidney issues, the drug was discontinued and another less effective medication was initiated. Subsequently, the infection worsened, with widespread tissue damage that required surgery.
After surgery, doctors were informed of a national shortage of sedative drugs, so the patient was prescribed a suboptimal medication resulting in unresolved pain. The patient then developed an overwhelming infection, resulting in fulminant sepsis that led to respiratory failure requiring placement on a ventilator. The end result was multisystem organ failure.
Pressors to support and elevate blood pressure were also in short supply, and after 3 weeks, the patient died of sepsis, leaving behind two children and a spouse.
Critical Shortages of Key Meds
More and more, patients are being subjected to ongoing critical shortages of all classes of medications, leading to a major break down in the way we usually treat patients. These drug shortages have had an impact on not only individual patients but also the entire healthcare system.
Drugs in short supply include sterile intravenous (IV) preparations such as antibiotics; IV fluids; medications to treat strokes, cardiac arrest, and other life-threating issues; and common everyday medications.
Two key areas of the hospital directly impacted by drug shortages are the ED and the ICU.
Critical shortages of key resuscitative medications include:
Major shortages have also been identified in medications used for cancer therapy. Such shortages affect the entire spectrum of how we provide care for patients.
Impact on the Healthcare System
Medication shortages impact our health delivery system by causing delays in procedures, surgeries, and other treatments, resulting in medical errors and adverse patient outcomes and ultimately driving up costs.
Longer hospital stays keep beds full, so patients have to be boarded in the ED, resulting in compromised patient care and adverse outcomes in an already strained healthcare system. Our model for a "modern health system" has never faced such external pressures.
Causes of Medication Shortages
Many variables contribute to the current medication shortages. The most important factor is that we no longer manufacture most medications within the United States. Moving production facilities abroad has caused more supply chain issues. This has also led to issues involving quality, sterility, and potency of medications manufactured outside the United States. Furthermore, there have been reports of counterfeit medications entering both the hospital and retail markets.
A recent Centers for Disease Control and Prevention report documented 22 people with suspected botulism from tainted or contaminated Botox administered in cosmetic spas in multiple states; 11 of the 22 persons required botulism antitoxin to resuscitate them. No one died, but this illustrates the potential harm associated with tainted or contaminated medications along with the need for proper administration of US Food and Drug Administration–approved medications by licensed professionals.
Addressing the Issue
This is unacceptable and untenable. How can we address these drug shortages? To begin with, the public must pressure the pharmaceutical industry and political leaders.
One of the simplest ways to address the problem is to return to manufacturing medications in the United States. This will assure that our supply chain is simplified and truncated and enhance our ability to ensure medication safety and security in our regulatory framework.
Another important benefit would be an increase in high-paying jobs in the manufacture and distribution of medications. The economic impact of implementing such changes could be significant.
We can't continue on the same path; change must occur to ensure safety of all patients who need medical care and access to every day and critical lifesaving medications.
Robert D. Glatter, MD, is an assistant professor of emergency medicine at Zucker School of Medicine at Hofstra/Northwell in Hempstead, New York. He is a medical advisor for Medscape and hosts the Hot Topics in EM series.
Peter J. Papadakos MD, is a professor of anesthesiology, surgery, neurology, and neurosurgery at the University of Rochester. He is also the director of critical care in the anesthesiology department at the University of Rochester Medical Center in Rochester, New York.