Update to critical shortage – IV fentanyl and hydromorphone

By Robert L. Benz MD, FACP FASN, Vice President of Medical Affairs, professor of Medicine, Lankenau Medical Center

Please see below the shortages of analgesics.  This is a national issue and not unique to LMC.

Attention to all Prescribers:

Here is an update on the acute critical shortage of IV fentanyl and hydromorphone (including PCAs) at LMC.

  • LMC is outof fentanyl and hydromorphone PCAs/drips.  Our pharmacists have, or are in the process of, contacting the providers to change to morphine or an alternative regimen for sedation.  We have asked the EPIC team to build an alert for the providers blocking them from ordering hydromorphone PCAs since all sites are now out.   We do not have an ETA on when this will be built and go live in EPIC.  We continue to order PCAs with hopes of getting an allocation.
  • Fentanyl injection for intermittent dosing(100 mcg/2ml vials).  LMC has a supply (for now) to continue accepting orders for intermittent dosing.  We continue to order with hopes of getting an allocation.
  • Hydromorphone injection for intermittent dosing.  LMC has about only a 5 day supply for the floors and a 17 day supply for our ORs. We continue to order with hopes of getting an allocation.
  • MLHS Pharmacy has received MEC approval (3/19/18) for the following automatic substitution by pharmacy. Once all of MLH Pharmacies are out of hydromorphone injection for intermittent dosing, we will change EPIC to instruct the providers to switch to morphine in the following manner.

 

Dose of IV Hydromorphone Temporary Therapeutic Substitution-same frequency
0.5mg IV hydromorphone 3 mg IV Morphine
1 mg IV hydromorphone 6 mg IV Morphine

 

Again please consider IV morphine, oral hydromorphone, oral morphine, other oral opioids, or fentanyl patches (were appropriate). Exercise extreme caution when switching between these products.

We expect this shortage to continue at least until May 2018 and will continue to keep you posted.

Please share this with your colleagues, peers, residents, physician assistants and nurse practitioners.

 

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