Access to ventilators aren’t the real risk when it comes to COVID-19, new data suggest… it’s that hospitals can’t get enough related medicines
The Society of Hospital Pharmacists of Australia has released the results of its first weekly COVID-19 Hospital Pharmacy Capacity Shapshot, which shows that hospitals’ orders for medicines necessary to support ventilated beds are not being met.
The SHPA says the data raises concerns that the planned return of elective surgeries will add further pressure to medicines supply.
Last week Prime Minister Scott Morrison announced that elective surgery would “gradually restart” from this week, after nearly a month of suspension due to the COVID-19 pandemic.
SHPA also says it refutes misconceptions that hospitals are stockpiling medicines during the crisis sparked by the novel coronavirus.
In releasing the findings, SHPA said that it supports the TGA’s ongoing collaborative effort to safeguard the country’s supply of essential medicines, which are critical to managing a surge in COVID-19 inpatient cases if this was to eventuate.
SHPA Chief Executive Kristin Michaels says access to key medicines, including propofol and cisatracurium, have emerged as factors likely to reduce Australia’s capacity to treat a surge of COVID-19 patients.
“Propofol is a key medicine used in the intubation of patients who require ventilation,” she said.
“In our snapshot on Friday 17 April hospital respondents only had enough propofol to treat patients in less than half the hospital beds they have been asked to set up.”
The snapshot showed that 66 of the 272 hospitals contacted by SHPA reported that they had only sufficient medicines to treat 774 critical COVID-19 patients – despite having plans in place for 1639 ventilator-capable beds.
If these drugs were to be used for other purposes, including usual usage and reactivating elective surgery, the number would be further decreased.
Eighteen of the hospitals reported having insufficient propofol to manage one single day of ventilated patients at their planned maximum capacity – and 15 said they didn’t have enough of the medicine to handle a single day of ventilated patients at half their planned maximum capacity.
Confidence in medicines supply was substantially higher in metropolitan locations than regional and rural areas.
“Just as Australia was asked to come together and increase ventilated intensive care capacity, SHPA has been working with partners to ensure we have enough medicines to provide care for Australians receiving care in these hospital beds.
“Hospitals have reported not having their orders filled for several weeks, with 80% of orders only supplied in part, regardless of hospital size, location or patient cohort, highlighting a supply chain in distress.”
Ms Michaels says the figures question the ability of Australia’s healthcare system to treat a potential COVID-19 surge and the timing of a return to elective surgeries.
“Stocks of these drugs are a tightly guarded secret nationwide and hospitals are poorly informed as to what stock they should expect to receive in coming weeks and months,” she says.
“Hospitals are implementing the national response to COVID-19 – including doubling their intensive care beds in many cases, which requires an increase in medicines to be operationalised – only to have commercial wholesalers and manufacturers unable to provide access to key medicines.
“We appreciate medicine wholesalers may have the best intentions, but they are not clinicians and do not have access to the information about pandemic scenarios and hospital service planning and delivery that must guide medicine orders.”
The snapshot also showed that supply of neuromuscular blockers are of the next most concern, particularly cisatracurium, which is the first-line agent in most circumstances.
Morphine supply remains an ongoing concern, as are Azithromycin shortages, due to its potential use against COVID-19as part of trial protocols.
Supply of antimicrobials appears strong at this time, however.
Ms Michaels says Australia’s hospital pharmacists are in lockstep with their colleagues to ensure the country is prepared for any COVID-19 scenario.
“The rapid preparations we are seeing across the country to ensure the very best care for Australians is not ‘stockpiling’, it is the prudent following of national COVID-19 response plans, ensuring every hospital has enough medicines to operate ventilated beds should demand increase.
“We need to ensure that, during the ongoing COVID-19 pandemic, every Australian can be assured of access to a fully resourced hospital bed; this means not only the assistance of a ventilator, if they need one, but the full suite of medicines required to treat a COVID-19 patient.”
Meanwhile Medicines Australia has said that it stands ready to support hospitals and healthcare workers as they recommence elective surgeries.
“Pharmaceutical manufacturers have worked with wholesalers, hospitals and the Federal Government to ensure there are supplies of medicines and products needed for surgery as it recommences,” says its CEO, Elizabeth de Somer.
“This includes increasing the supply of critical care medicines and protective equipment for hospital workers as well as diagnostics and devices like ventilators.”
Medicines Australia welcomed the announcement that elective surgery is to recommence, but it also urged Australians to ensure they are as healthy as possible by maintaining their usual health care and continuing to see GPs and other health providers as normal.
SHPA’s new weekly snapshot will gather critical information on hospital access to medicines, focusing on medicines used in ICU care, and the hospital pharmacy workforce during the COVID-19 challenge, says Ms Michaels.
“The data supports SHPA’s advocacy for support for hospitals, including supply of medicines, during this period,” she said.
“Following our landmark 2017 medicines shortages study prompted national regulatory change to ensure mandatory reporting, SHPA is perfectly positioned to feed up essential frontline data from members to inform Australia’s COVID-19 response.”