Report a drug shortage
1. What drug is in short supply (you can report another shortage after the next series of questions)?
*
a) Acetaminophen (IV) (Ofirmev)
b) Aminocaproic Acid Injection
c) Atracurium or Cis-Atracurium
d) Atropine
e) Bupivacaine
f) Calcium Chloride Injection
g) Dobutamine
h) Dopamine
i) Epinephrine
j) Fentanyl
k) Glycopyrrolate
l) Hydromorphone (Dilaudid)
m) Ketamine
n) Labetalol
o) Lidocaine Hydrochloride Injection
p) Midazolam
q) Morphine
r) Neostigmine
s) Nitroglycerine
t) Norepinephrine
u) Ondansetron Hydrochloride Injection
v) Potassium Hydrochloride Injection
w) Propofol (Diprivan)
x) Rocuronium
y) Ropivacaine
z) Sodium Bicarbonate Injection
aa) Sugammadex (Bridion)
bb) Vecuronium
cc) Other (type in box below)
Other type of drug in short supply.
2. For how long has it been unavailable?
*
A week
A month
Greater than a month
3. Where is the facility that you experienced the shortage?
4. Type of Facility
Hospital
ASC
Medical Office Building
5. Do you know why there is a medication shortage?
No
Yes (please provide comments below)
Please comment on why there is a medication shortage.
6. If yes, what is your facility doing to accommodate or adjust for shortages?
I don’t know
Using drug substitutions
Postponing surgery
Other (Please add comments below)
What is your facility doing to accommodate or adjust for shortages?
Report another shortage?
Yes
No
1. What drug is in short supply (you can report another shortage after the next series of questions)?
*
a) Acetaminophen (IV) (Ofirmev)
b) Aminocaproic Acid Injection
c) Atracurium or Cis-Atracurium
d) Atropine
e) Bupivacaine
f) Calcium Chloride Injection
g) Dobutamine
h) Dopamine
i) Epinephrine
j) Fentanyl
k) Glycopyrrolate
l) Hydromorphone (Dilaudid)
m) Ketamine
n) Labetalol
o) Lidocaine Hydrochloride Injection
p) Midazolam
q) Morphine
r) Neostigmine
s) Nitroglycerine
t) Norepinephrine
u) Ondansetron Hydrochloride Injection
v) Potassium Hydrochloride Injection
w) Propofol (Diprivan)
x) Rocuronium
y) Ropivacaine
z) Sodium Bicarbonate Injection
aa) Sugammadex (Bridion)
bb) Vecuronium
cc) Other (type in box below)
Other type of drug in short supply.
2. For how long has it been unavailable?
*
A week
A month
Greater than a month
3. Where is the facility that you experienced the shortage?
4. Type of Facility
Hospital, greater than 1000 beds
Hospital, 500-999 beds
Hospital, less than 500 beds
ASC
Office
5. Do you know what is causing the medication shortage?
Yes
No
6. If yes, what is your facility doing to accommodate or adjust for shortages?
I don’t know
Using drug substitutions
Postponing surgery
Other (Please add comments below)
What is your facility doing to accommodate or adjust for shortages?
Report another shortage?
Yes
No
1. What drug is in short supply (you can report another shortage after the next series of questions)?
*
a) Acetaminophen (IV) (Ofirmev)
b) Aminocaproic Acid Injection
c) Atracurium or Cis-Atracurium
d) Atropine
e) Bupivacaine
f) Calcium Chloride Injection
g) Dobutamine
h) Dopamine
i) Epinephrine
j) Fentanyl
k) Glycopyrrolate
l) Hydromorphone (Dilaudid)
m) Ketamine
n) Labetalol
o) Lidocaine Hydrochloride Injection
p) Midazolam
q) Morphine
r) Neostigmine
s) Nitroglycerine
t) Norepinephrine
u) Ondansetron Hydrochloride Injection
v) Potassium Hydrochloride Injection
w) Propofol (Diprivan)
x) Rocuronium
y) Ropivacaine
z) Sodium Bicarbonate Injection
aa) Sugammadex (Bridion)
bb) Vecuronium
cc) Other (type in box below)
Other type of drug in short supply.
2. For how long has it been unavailable?
*
A week
A month
Greater than a month
3. Where is the facility that you experienced the shortage?
4. Type of Facility
Hospital, greater than 1000 beds
Hospital, 500-999 beds
Hospital, less than 500 beds
ASC
Office
5. Do you know what is causing the medication shortage?
Yes
No
6. If yes, what is your facility doing to accommodate or adjust for shortages?
I don’t know
Using drug substitutions
Postponing surgery
Other (Please add comments below)
What is your facility doing to accommodate or adjust for shortages?
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7. Profession
Anesthesiologist
Certified Anesthesiologist Assistant
Certified Registered Nurse Anesthetist
Medical Student Membership
Resident/Fellow
8. Subspecialty
Cardiothoracic Anesthesia
Critical Care Anesthesia
Neurosurgical Anesthesia
Obstetric Anesthesia
Pain Medicine
Pediatric Anesthesia
Ambulatory Anesthesia
Regional Anesthesia
N/A
9. If we may call or email you with follow-up questions, please provide your contact information:
Please do not contact me
10. Please share any other information that you would like to report.
Submit
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