A message from the Safe Anaesthesia Liaison Group (SALG)
NHS England and DHSC were informed last week that Martindale are experiencing a short term out of stock of Phenylephrine 100mcg/ml 10ml injection, stock at all wholesalers is now exhausted and re-supply is expected w/c 26 August 2019.
The CMU have contacted all suppliers of phenylephrine 1mg in 10ml (0.1mg /ml) injection (licensed and unlicensed) and no supplier is able to support this out of stock period. The sole supplier of a phenylephrine 0.5mg in 10ml Prefilled syringe is also likely to go out of stock shortly and is unable to make any additional supply available.
The medicines supply team (MST) at DHSC are working with the importers to see if they can source the product but at present no stock is available to order. The MST will contact your regional procurement lead with further information if this situation changes.
Due to the unavailability of the low strength 1mg in 10ml ( 0.1mg /ml ) product , CMU have contacted the suppliers of high strength phenylephrine 10mg in 1ml ( 10mg/ml ) injection. Advanz have confirmed they have sufficient phenylephrine 10mg in 1ml (10mg/ml ) injection to support all trusts over this period. This stock is available to order from Alliance.
Working with the Royal College of Anaesthetists, the Safe Anaesthesia Liaison Group (SALG), have spoken with suppliers of the alternative agent Metaraminol (Torbay Pharmaceuticals) and they can support this out of stock period with either 0.5mg/ml or 10mg/ml Metaraminol ampules.
This supply issue will need very careful management at a local level by an identified lead anaesthetist, in conjunction with the organisation’s Medication Safety Officer. The local management plan will need to document a risk assessment of the following potential actions, the agreed plan and supporting documentation:
- Possible prioritisation of remaining phenylephrine 1mg in 10ml ( 0.1mg /ml ) injection.
- Management plan for a possible switch from Phenylephrine to Metaraminol.
- Management of two different strengths of phenylephrine injection within pharmacy and across trust.
- The development of supporting information for clinical colleagues. Please refer to national IV monograph for phenylephrine on MEDUSA for information on dilution and suitable diluent, or local guidelines, where available.
- Risk minimisation measures developed with guidance from local Medication Safety Officers (MSO) need to be put in place to reduce the risk of a dosing error, such as flagging up the higher strength of the injection and standardisation of the dilution of the 10mg/1mL injection.
- Trusts with aseptic manufacturing capabilities may want to consider preparing ready diluted phenylephrine solution to mitigate risk associated with ward based dilution.
Local Action Required
1. Pharmacy to assess local stock holding and develop a management plan in conjunction with clinical colleagues.
2. Management plan to be communicated within pharmacy and to all relevant clinical teams including but not limited to Accident and Emergency departments, Theatres, Intensive Care Units and Obstetrics departments.
Please contact your regional procurement lead should you need further information or support.
The Safe Anaesthesia Liaison Group (SALG) is a group that brings together interests of a number of different organisations across the UK and members are nominated by the organisations that they represent.