The ongoing national shortage of sodium bicarbonate injection has hospitals prioritizing its use on the basis of patients’ clinical needs and centralizing the stock, according to the results of a survey conducted by the ASHP Center on Medication Safety and Quality.
Nearly all 456 people who participated in the online survey from June 26 through July 9 reported that their hospital has been affected by the shortage.
“What stands out to me the most is ... the severity of what’s happening,” said Deborah Pasko, ASHP’s Director of Medication Safety and Quality.
The ASHP Center on Medication Safety and Quality, where Pasko works, today reported that:
62 percent of the 394 respondents who answered the question about the severity of the shortage rated it as severe, impacting their hospital’s daily operations and patient care.
31 percent described the shortage as problematic but not yet bad enough to affect patient care.
7 percent indicated their hospital has been able to obtain supplies of sodium bicarbonate injection, albeit with extra effort.
Asked to indicate the impact the shortage has had on patient care, most respondents indicated that their hospital or health system has:
Prioritized patients on the basis of their clinical needs (85 percent of 396 respondents)
Used alternatives to sodium bicarbonate injection (71 percent of 397 respondents)
Changed clinical protocols (52 percent of 396 respondents)
“Bicarb has a very significant place in clinical care,” Pasko said, pointing to sodium bicarbonate’s use in advanced cardiovascular life support protocols.
The shortage’s impact on patient care has manifested in other ways as well:
18 percent of the respondents reported that their hospital had purposely delayed treating a patient.
8 percent said their hospital had cancelled a procedure or surgery.
Centralizing the hospital’s stock of sodium bicarbonate injection — an action reported by 84 percent of the 395 respondents who answered the survey question — is the most common step taken to date for addressing the shortage.
The second most common step, reported by 63 percent of 397 respondents, is ordering sodium bicarbonate injection from an FDA-registered outsourcing facility or at least asking such a facility whether it could supply sodium bicarbonate injection.
Some 37 percent of respondents reported doing nothing other than waiting for the release of additional product, a step that Pasko said seems to indicate that “they don’t know really what to do.”
In all, the respondents were presented six specific ways of coping with the shortage. Two percent of the respondents admitted their hospital compounded sodium bicarbonate injection from powder without using the high-risk procedures described in the United States Pharmacopeia.
Pasko said ASHP will use the information gathered through the survey when talking to FDA about the status of the sodium bicarbonate shortage. ASHP will also use the information when contacting other healthcare professional associations to help “triage” clinical protocols, she said.
A plurality of the survey respondents, 44 percent, who answered questions about shortage severity, impact, and steps taken to date hailed from hospitals having 201 to 500 beds. The rest of the respondents were somewhat evenly split between hospitals with 200 or fewer beds and hospitals with more than 500 beds.