Similarly, Children's Hospital in New Orleans, which has been forced to buy heparin products with half the potency it used to get, has given nurses extra training in administering the drug. The hospital also keeps the entire supply in its pharmacy so that nurses are automatically reminded to use a higher concentration when picking up the medication, said Helen M. Calmes, assistant director of pharmacy.
"You just don't want to put them out there for someone to grab," Calmes said.
Heparin supply was disrupted after hundreds of people suffered allergic-type reactions from contaminated heparin. Baxter was forced to recall most of its heparin products. In the company's absence, two smaller makers have significantly increased production, and federal health officials insist that supplies are sufficient.
But the American Society of Health-Systems Pharmacists, representing 30,000 pharmacists at hospitals and other medical facilities, lists heparin among the drugs in short supply. And pharmacists at several hospitals around the country said in interviews that their suppliers were rationing heparin products due to the shortages.
"They're scrambling to make do with whatever heparin products they can get their hands on," said Ronald A. Hartmann, vice president of the pharmacy division at MedAssets Supply Chain Systems in St. Louis, which negotiates drug purchases on behalf of 1,000 hospitals, dialysis centers, surgery clinics, nursing homes and doctor's offices.
Northwest and Sinai hospitals have been able to muster just a third of their normal supply because of rationing by their supplier, DiBona said. Their supplier, McKesson Corp., declined to comment.
To fill the gaps, some hospitals have stepped up use of alternative drugs, including a more purified form of heparin, that works just as well at preventing blood clots. But the alternatives are far more expensive, and hospitals have scrounged for whatever dose sizes and concentrations of heparin they can get their hands on.
For the University of Utah Hospitals and Clinics, that has meant buying heparin in 20-dose vials rather than in syringes filled with a single dose that a nurse could readily administer, said Erin R. Fox, a pharmacist at the Salt Lake City hospitals, which monitors drug shortages for the American Society of Health-System Pharmacists.
