A national shortage of medicine has prompted central Ohio hospitals to work together to keep patients safe, and that includes sharing information and substituting drugs.
But there is growing concern among hospital staff and administrators that the time may come when there are no substitutes left for patients.
When a patient arrives at a hospital, he or she expects the medicine they need to be there. However, that may not be the case.
"It's something that affects every hospital throughout the United States," said Ohio State pharmacy associate director Trisha Jordan.
Pharmacists noticed the shortage first. Drugs they ordered were in short supply, especially intravenous drugs and those for chemotherapy.
"There are patients that their therapy has been on hold, their chemotherapy, or their regimen has been changed," Jordan said.
Anesthesiologists, who put patients to sleep for surgery, noticed the shortage, too.
"You get a new drug that's missing and there's really no rhyme or reason to it, except that we're told there's a shortage," said Grant Medical Center anesthesiologist Dr. Jess Lopez.
According to the American Hospital Association, nearly 200 drugs are in short supply. Those shortages are in turn driving up costs.
"A drug that you would commonly use on a daily basis that usually costs somewhere between 25 cents to $1 is just gone," Lopez said.
Experts agreed that the reasons for the shortages are complex. Manufacturing problems, including quality and availability of imported raw materials, are part of the problem. And as more generic drugs become available, it is not as profitable for companies to keep making older and cheaper drugs.
Now, each hospital in Columbus works in-house, as well as with other hospitals, to find drugs in short supply. Mount Carmel Hospital quality and safety nurse Gayle O'Brien said the process is working.
"We've done a great job of insuring patient safety, but to do that requires almost hour by hour of inventory management," she said.
Hospitals are also finding ways to conserve the drugs they have. OhioHealth chief medical officer Dr. Bruce Vanderhoff said the focus is on limiting waste.
"Provide unit dosages to the patient at the bedside that are designed to minimize wastage," he said.
The hospitals are also suggesting alternatives to doctors, who find ways to make treatment work.
Still, they worry about complications.
"We're having to make adjustments in the hospital, and even then we don't have the medications we need," said family practitioner Dr. Sarah Sams. "So, it sometimes causes additional complications that we weren't accounting for."
Nurses are troubled by the shortage of critical care medicines -- and unwelcome surprises. In one case, a nurse asked for a caffeine drug for a patient with an anesthesia headache, but the pharmacy was out.
The workaround: give the patient a Mountain Dew.
Doctors and nurses said they continue to worry about the day when there is a serious ailment and a medicine might not be there.
"We don't have another drug like that, and what are going to do?" O'Brien asked.
All three major hospital systems in central Ohio said on Monday that they are doing a good job of treating patients and keeping them safe, and a Nationwide Children's Hospital spokesman said the hospital has been able to get the medicine it needs.
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