Approved Hospital Formulary
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Approved Hospital Formulary
03/15/20 dc MDI Issue
March 16, 2020
From: "David Collette" <david.collette@hhsys.org>
To: "tracy doughty" <tracy.doughty@hhsys.org>, "gregory lochner" <gregory.lochner@hhsys.org>, "arin zapf" <arin.zapf@hhsys.org>, "jack adams" <jack.adams@hhsys.org>, "b catherine brown" <b.catherine.brown@hhsys.org>, "brian buchmann" <brian.buchmann@hhsys.org>, "cheryl case" <cheryl.case@hhsys.org>, "cheryl neville" <cheryl.neville@hhsys.org>, "ryan murray" <ryan.murray@hhsys.org>, "Robert W Jr Chappell" <robert.chappell@hhsys.org>
Cc: "Pharmacy" <grp_pharmacy@hhsys.org>
Sent: Sunday, March 15, 2020 1:24:42 PM
Subject: MDI Issue
After meeting with various leaders across the system, we have developed a plan for the use of bronchodilators in inpatients.
Situation - The demand for albuterol metered dose inhalers is expected to rise as people in North Alabama begin to test positive for COVID-19. We have a limited supply of albuterol MDI and our wholesaler is allocating only 5 inhalers of each strength per day.
Background - Patients in respiratory distress, especially those with COVID-19, generally require bronchodilation, with albuterol being a first line agent. HH's formulary designates albuterol via nebulization as the workhorse delivery method, with MDIs only used in specific circumstances. However, it is known that nebulization with a non-closed system has a risk for droplet dispersion. Fortunately, there are closed systems (e.g., Aerogen) that are available and in use at HH, but shortages are almost certain to occur, probably sooner than later. Once we run out of Aerogenclosed system devices, delivery of albuterol via MDI would be the most appropriate method for COVID-19 positive patients.
Assessment: Albuterol is an essential drug for COVID-19 positive patients and we are working to preserve our supply of it as well as our supply of Aerogen closed-system devices. Our Pharmacy buyer continues to purchase our designated allocation of inhalers daily on all accounts, including our retail accounts; Ron Stansell will work to manage the supply of the Aerogen closed system devices.
Review: Until further notice, we will follow these guidelines:
- albuterol metered dose inhalers will be restricted to COVID-19 positive patients in whom we are unable to use a closed system for nebulization
- all other patients who required inhaled albuterol, including those being evaluated for COVID-19 but not yet confirmed positive by the state, will receive albuterol via nebulization
- staff should wear appropriate PPE as directed, especially when administering these drugs to a presumptive or positive COVID-19 patient
- tomorrow we will evaluate the distribution of albuterol inhalers through our retail pharmacies and via Meds-to-Beds, possibly reserving our entire supply for these patients
Please feel free to share this email with your staff. We have already experienced a high volume of calls requesting albuterol MDIs, but our pharmacists have now been instructed to only fulfill these orders for a COVID-19 positive patient where closed system nebulization with the Aerogen product is not possible.
I am available via phone as needed: 256-527-2560. DAVID COLLETTE