UF HEALTH SHANDS ADAPTS TO INJECTABLE OPIOID SHORTAGE
National crisis may last through mid-2019
This spring, UF Health rolled out plans to help respond to a national crisis: The U.S. Food and Drug Administration has confirmed a shortage of injectable opioid medications. These include critical pain-relief drugs such as fentanyl, hydromorphone and morphine. Providers use these staple medications to treat a variety of patients receiving hospital and outpatient care.
It is important to emphasize that UF Health currently has an ample supply of oral opioid medications and non-opioid medication alternatives.
The injectable opioid shortage is due to manufacturing disruptions, including last year’s hurricane damage to factories and delays as facilities meet new stringent FDA regulations. Another factor is a supplier shortage of parts needed to produce the syringes used to administer these medications.
Health care providers nationwide must carefully manage available supplies and use alternative pain management options to support patients. The shortage is expected to last through mid-2019.
UF Health is proactively managing inventory to preserve limited injectable opioids for our most vulnerable patient populations, recognizing that the timeline for resolution is months out. Rethinking how we purchase, store, prescribe and administer these drugs will capitalize on the innovation and expertise of everyone involved. It will require a philosophical shift from a preference to rely on injectable drugs and take advantage of other options available to keep patients as comfortable as possible.
We’re confident we will weather this crisis and serve our patients and communities who entrust their care to us. Thank you for your attention and support.
For ongoing information about the national injectable opioid shortage, please visit the “Emerging Issues & Response” site on the Bridge (bridge.UFHealth.org/response/ or look under the “News & Events” tab). There, you’ll find a fact sheet, scripts and helpful pain management resources.
HERE AT UF HEALTH:
- We’re committed to our patients’ pain management, safety and comfort.
- We’re carefully adapting pain management practices and coordinating across our hospitals and outpatient settings.
- We’re responsible stewards of these critical resources. We value conservation and innovative alternatives.
- We’re engaged in careful and deliberate decision-making to help us through the long haul.
- An interdisciplinary work group is meeting frequently to address how we purchase, store, prescribe and administer pain medications. Our teams are taking advantage of the vast clinical and research expertise at UF Health, from the UF College of Medicine, the UF College of Pharmacy, the UF Health Shands hospital system and the UF Health Physicians outpatient practice network.
- Experts representing pharmacy, supply chain, critical care, oncology, pediatrics, burn, medicine, surgery, anesthesia, emergency medicine, nursing, operations and many other specialty areas are united in this effort.
- As our best practices change, faculty and staff will hear from leaders with new instructions.
ACTION STEPS UNDERWAY NOW
- The interdisciplinary work group has implemented the following actions with approval from physician
leadership in affected areas. - Proactively modify order sets:
- Ensure oral and injectable opioid and non-opioid options are optimized.
- Remove injectable opioids from general medicine and hospital medicine order sets.
- Clear Epic favorites and uncheck orders to force more intentional ordering.
- Evaluate opportunities to time-limit or dose-limit injectable opioid orders.
RESTRICTIONS IN PLACE
- Patient-controlled analgesia, or PCA, must meet criteria for use.
- IV meperidine is approved for limited use in the PACU.
- IV fentanyl must meet criteria for use or select alternative agent.
- IV hydromorphone cannot be ordered in Epic; consider alternative agent.
- IV morphine use is flagged; Epic has a soft alert recommending the use of an alternative agent if possible.