If the shortage is causing EMS personnel, emergency physicians, and ED nurses to use substitute medications or ones that are not in the usual practice, there should be timely communication and extra safety practices implemented to facilitate good patient care. For example, if paralytic agent supplies are restricted, all providers must be aware of the limitation of substitution with other medications, including dosing changes. Emergency department program materials need to be available in the department to update staff and advise at the point of use about correct dosing, compatibility issues, and side effects. Some emergency departments are putting up safety cards in their medication rooms so staff members have an immediate visual prompt.

All emergency department staff members—especially the nursing personnel who do most of the medication administration—need to be educated regarding the ongoing shortage issues. The FDA suggests not writing the extension information on the drug container. An alternate mechanism will need to be crafted to allow personnel to understand the extension.

There are other detailed medication management strategies that may be integrated by the joint emergency department and pharmacy leadership team to address the issue. For now, clinicians need to be continually updated on shortages. All staff should rotate medications in an attempt to use those medicines closest to their expiration dates. ACEP will provide updates regarding any future FDA actions related to critical drug shortages.