Medicines are, for various reasons, not always available. Jeroen Hassink, hospital pharmacist, cites a current case: 'Since this spring there has been a supply problem with ondansetron syrup (Zofran), an anti-nausea drug. This is a European problem, so we can only buy limited quantities from abroad. To keep the drink available for the smallest children, we have asked the doctors to prescribe as many (melting) tablets as possible for older children. This solution is more stressful for the children and parents because they now have to swallow a tablet or administer it through the tube.'
Impending shortage
Recent years have seen an increase in the number of (impending) shortages of key drugs used to treat children with cancer. Commonly used drugs such as methotrexate and co-trimoxazole tablets, Erwinase injection powder, aprepitant suspension, tramadol drops have experienced shortages of several weeks or months on the Dutch market.
The pharmacy continuously monitors potential shortages. Jeroen Hassink and pharmacy assistant drug purchase Anita de Kok play an important role in this. Jeroen says: 'We are building up more and more experience. It's a lot of work behind the scenes, but if no care professional notices anything, we're doing it right. Unfortunately that doesn't always work out.’
Solutions
From experience, Jeroen knows what options are available for resolving a potential shortage of a drug. He mentions a few ways: 'Sometimes another Dutch supplier can supply an equivalent product, increasingly a drug is imported from abroad or we ask a compounding pharmacy to make an equivalent product. And if there is no other option, we ask physicians to prescribe another form of administration or therapeutic alternative, as with the shortage of piritramide injection fluid.' All alternatives require careful handling and preparation to avoid medication errors. In addition, alternatives are often more expensive so the financial side also requires attention.
Communication
Depending on the type of medicine and the nature of the shortage, the hospital pharmacy provides information to those involved such as doctors, nurses and parents. ‘In my view this communication is a challenge,' says Jeroen Hassink. ‘You only have to provide current and relevant information about such an impending shortage, without causing panic. The short lines of communication that we have in the Máxima Center are very pleasant. When Varicella Zoster immunoglobulin was in short supply, the infectiologists immediately thought along about an alternative. That went very smoothly. This is the way it should preferably always be.’