It’s no secret that drug and supplies shortages continue to plague every hospital’s pharmacy operations.
It’s a complex problem with several causes. In some cases, new medications that work better than older formulations become popular quickly and manufacturers have a hard time keeping pace with demand. In other instances, companies that made products in Puerto Rico still haven’t fully recovered from the double-hit of Hurricanes Maria and Irma.
Dealing With the Recent Drug Shortage
Here are some tips to help manage drug shortages:
- Keep your eyes and ears open for new drug shortages
Pay attention to what’s going on in your pharmacy and out in the industry. Listen when your pharmacy buyer says they did not receive an ordered medication. This may be a sign of an impending shortage.
Watch pharmacy listservs. Review the ASHP and FDA drug shortage lists. Listen to your reps when they call or send emails. These are all good sources of information on drug shortages in other states that may impact your hospital soon.
- Assess the impact of a new shortage on your patients
Inventory your supply in the pharmacy and in the hospital. Determine your utilization and days- supply-on-hand. Then, determine what your critical level to operate safely and change your buying habits if necessary.
- Have a drug shortage team with a checklist
Harness your in-house expertise. Involve pharmacy, IT, nursing and the medical staff in safely and efficiently managing shortages. Check-off the changes required in each step of the drug distribution process (e.g. obtaining therapeutic alternative, order sets, smart pumps). There’s a role for everyone to play to help keep patients safe during shortages:
- Pharmacy buyer: Manage manufacturer and wholesaler allocation programs, communicate supply release dates, and obtain supplies of alternative drugs.
- Pharmacy clinical coordinator: Identify therapeutic alternatives and communicate with the medical and nursing departments about updates to order sets.
- Medical staff: Approve therapeutic alternatives, and document and communicate about any restrictions based on indications for use.
- IT: Update hospital information systems and smart pump libraries with alternative therapies/revised order sets, test clinical alert support systems, add new bar codes, and update medication labels.
- Pharmacy director: Consolidate remaining drug supply, manage conversion from existing drug to therapeutic alternatives, and communicate with administration.
- Pharmacy operations: Convert existing orders to therapeutic alternatives, and answer provider and nursing questions.
- Nursing: Understand new medication strategies and integrate it into patient care. Plan ahead, if the medication has to come from the pharmacy instead of the automated dispensing cabinet or floor stock. Become familiar with therapeutic alternatives. Communicate with pharmacy about ideas that could improve or clarify new processes.
- Minimize the risk for error
Shortages can introduce risk for error at several points in your drug distribution system. One of the most error-prone spots comes with changing drug concentrations, such as replacing heparin premix 50 units/ml with heparin premix 100 units/ml.
Consider a big-bang approach and remove all of the remaining “old” concentration (heparin 50 units/ml) with the “new” concentration (heparin 100 units/ml). Remember to check surgery, labor and delivery, and other out-of-the-way places that seldom use the drug.
Make the new concentration as obvious as possible in storage areas, in compounding recipes, and on labels. Remove the “old” concentration from the medication order pathway, order sets and the smart pump library. Update your references and order forms.
After making all the changes, walk-through each step again to mitigate new errors that may have been inadvertently added to the system.
- Over-communicate to physician leadership, nursing and medical staff
It’s vital that your pharmacy communicates information about drug shortages as quickly and often as possible. Give updates as part of your daily safety huddles or patient care rounds.
Use your hospital intranet to provide current information throughout the facility. Post signs and memos in the medical staff lounges and nursing break rooms. Include articles in pharmacy-nursing or medical staff newsletters.
Make drug shortages a standing agenda topic at P&T, quality or medical department meetings. Be proactive and review pertinent information from the FDA, ASHP and drug manufacturers before the shortage affects your hospital. This gets stakeholders thinking about a solution before it’s a problem and reduces the tendency to blame pharmacy for the shortage.
Above all, make sure the pharmacy staff is kept up-to-date. Have a white-board in the pharmacy dedicated to drug shortages. Make sure the staff knows what caused the shortage, anticipated duration, and therapeutic alternatives, so that they can communicate confidently and accurately with staff.
Unfortunately, drug shortages aren’t going away anytime soon. That’s why it’s important for your team to identify appropriate substitutions before you run out of your first-choice medication or supply.