The Duoneb shortage (as well as the individual components albuterol and ipratropium nebs) has reached a critical point and we have approximately 2 weeks' supply on hand based on historic usage. 

Our buyers and central pharmacy leadership have worked to try to improve our supply, but little is available at this point. Also, we have been working with Respiratory Therapy to judiciously use these products. Respiratory has existing protocols for them to evaluate patients and take some actions with regards to respiratory treatments, including

As such, you may see numerous changes to respiratory medication orders, including schedule changes, drug changes, route changes, and/or discontinuations. These orders are generally OK to verify (unless some aspect is obviously incorrect) and will have the RT's electronic signature as 'no cosign required.' If you have any specific questions about the appropriateness of these changes, please contact the respiratory therapist. Additionally, pharmacists should evaluate all Duoneb orders closely during profile review to determine if changes can be made to treat only the patients who will most benefit from this medication. Again, work with your units' RT on these issues.

We have ordered some additional levalbuterol nebs as well as albuterol inhalers, but these supplies will likely be exhausted if the Duoneb shortage lingers.

If you have any questions, please feel free to contact me. DAVID