In 2023, the healthcare industry continues to grapple with the persistent challenge of drug shortages. According to the American Society of Health-System Pharmacists (ASHP), drug shortages are at the highest they’ve been in nearly a decade, emphasizing the urgent need for proactive planning and preparation. As hospitals strive to ensure the highest quality of care for their patients, it has become crucial to develop robust strategies to effectively manage and mitigate the impact of drug shortages.
Understanding the Causes of Drug Shortages
Several factors contribute to the prevalence of drug shortages in today’s healthcare landscape, including:
The production of most drug shortages is delayed due to quality issues at the manufacturing site. Tight profit margins along with a variety of complex factors often limit the number of drug manufacturers. For example, a single manufacturer may have the majority share of the market for a specific drug therapy. So, if they face delays due to quality control, other manufacturers with a smaller capacity aren’t able to take on the extra load.
Shortages of raw materials
Rare, raw materials shortages, like those during the COVID-19 pandemic, can result in substantial disruptions and delays, especially if there is only one supplier. However, because the sources of raw materials are considered proprietary, manufacturers rarely disclose the information publicly, making it difficult to accurately determine the problem.
In addition to production issues, decisions made by the manufacturer on the business side of things can have a significant impact on drug shortages as well. This can include anything from the availability of generic products or drug approval status to regulatory compliance and patent expiration.
The just-in-time inventory management strategy used by most manufacturers, distribution centers, and healthcare organizations is standard business practice. While it is efficient in minimizing expenses and increasing inventory turns, it leaves very little room for sudden drug shortages. Unexpected delivery delays, inconsistent ordering practices, or being dependent on a particular wholesaler are among many of the variables that can affect inventory levels.
Natural disasters and emergencies
Pandemics, natural disasters, and other types of community emergencies can have a significant impact on the supply chain, leading to drug shortages. Healthcare organizations around the world have had to respond to the pressures of drug shortages due to COVID-19 as they struggled to meet the demands for medications and treatments.
Planning for Drug Shortages
To effectively manage drug shortages and minimize their impact on patient care, hospital pharmacies can develop a clearly defined management strategy and put it in place well before a shortage occurs.
Establish a multidisciplinary drug product shortages team
Form a dedicated team comprising key staff who are responsible for purchasing, preparing, and dispensing procedures, as well as individuals in charge of data gathering, communications, and implementing technology changes. These may include pharmacists, directors of pharmacy, pharmacy technicians, physicians, nurses, administrators, IT, and supply chain experts. This team should regularly monitor their drug supply and collaborate to develop strategies for addressing shortages, meeting monthly, or even weekly, depending on how many shortages they are facing.
Develop drug shortage protocols
Create a formal process specific to the individual healthcare facility that includes comprehensive protocols and guidelines to address drug shortages. These protocols should include decision-making procedures for alternative drug selection, dosing adjustments, therapeutic substitutions, and rationing strategies, while ensuring patient safety and quality of care. To safeguard against error, the same steps should be followed any time there is a change in drug product in the system.
Enhance communication and collaboration
Internally: Once the strategies have been developed, communicate them to the rest of the team – nursing staff, physicians, pharmacy techs, IT, etc. Then when a shortage is anticipated, alert them and gather data about how they utilize the drug and the amount of inventory left.
Externally: Strengthen communication channels with pharmaceutical manufacturers, wholesalers, and other healthcare facilities to gain real-time information about potential shortages. Collaborate with local and regional healthcare networks to share resources and develop contingency plans. At CompleteRx, our vast network of buyers regularly communicates with one another, sharing information about shortages, where they sourced alternatives, and pricing.
We also host an annual buyers’ meeting where ongoing education and training is provided, which is especially beneficial to the buyers who were promoted internally from a technician role and didn’t receive adequate preparation to navigate the ins and outs of purchasing.
Maintain a robust inventory management system
Implement an efficient inventory management system that provides real-time visibility of drug supplies, expiration dates, and utilization patterns. This system should enable accurate forecasting and prompt ordering to prevent stockouts and anticipate potential shortages.
Understanding your own site-specific utilization is crucial. Every hospital is unique. For example, a stroke center will need different types and amounts of certain drugs vs. a rural hospital. Creating a list of the specific drugs needed, the inventory on hand, and how long it will last, allows healthcare providers to foresee shortages and place orders accordingly.
Emphasize awareness and promote training
Routinely monitor drug shortage lists, such as the ones regularly updated by the FDA and ASHP. It could also be beneficial to promote awareness about the importance of conservation practices, appropriate utilization, and alternative treatment options to ensure optimal patient outcomes.
Today’s drug shortages pose significant challenges to hospitals and healthcare providers, requiring proactive planning and preparation. By understanding the underlying causes and implementing effective strategies, hospitals can minimize the impact of drug shortages on patient care. Through formal processes, collaboration, and communication, healthcare institutions can foster resilience and adaptability, ensuring the continued delivery of high-quality care, even in the face of drug shortages. Together, we can navigate these challenges and work towards a more robust and sustainable healthcare system.