The management of drug shortages tends to be a complex procedure, especially in a hospital setting as the drug turn-over volumes are tremendous. These health facilities are also more inclined to use high-costing, advanced, and single-source medicines that are vulnerable to frequent supply disruptions.
Nonetheless, pharmacists are not all helpless when confronting drug shortages. In fact, there are multiple solutions to reduce the resulting chaos and to minimise the damage to the healthcare system and patients. Here we will look at 4 effective and most commonly employed strategies to handle the challenging situation.
1. Confirm shortage through inventory assessmentOften, pharmacists in charge of the drug inventory will be notified beforehand if there is any upcoming disruption in drug supply, barring unforeseen incidents. There will be a buffer period within which existing drug supplies will still be sufficient to support routine dispensing by the pharmacy.
In addition, the pharmacist in charge should also determine what the causes of the shortage are, and establish how long the disruption will last. Such clarification will help pharmacists to gauge the impact of the drug shortage and plan accordingly. For example, a lack of raw material or a change in government regulation will probably result in prolonged interruptions in drug supply, whereas manufacturing problems are mostly resolved within a few months.
2. Identify alternative or therapeutically equivalent drugsThe next step in managing a drug shortage crisis is to identify alternative treatments to replace the unavailable product. This seemingly straightforward step must be taken with caution as it involves multiple stakeholders of the healthcare system. Clinical decisions regarding the substitution must be made in collaborations with staffs from the medical, nursing and pharmacy departments. Agreements must be sought and approved by relevant authority of the health facilities.
Once such conclusions have been achieved, the pharmacy department should begin to stockpile the alternative drugs in the agreed quantity. Other related procedures such as altering the pharmacy distribution process, bar coding (if any) and appropriate notification to the pharmacy staffs have to be put in place prior to implementing any substitution policy with the alternatives.
3. Patient categorisation and prioritisation to receive drugsAnother workable measure to handle a drug shortage is to categorise patients according to their condition and prioritise patients to receive drugs in short supply. These decisions should also be made by a multi-disciplinary team to incorporate expert opinions from different fields.
The activity of categorising and prioritising patients should be extended to the alternative treatments as well, in order to create a well coordinated and complementary approach to handling the crisis. Local guidelines and policies may be developed when necessary too.
4. Establish good communication with other health sitesIt is a common practice, at least in the public sector, for pharmacists in one health site to borrow medicine from other health sites during drug shortages. Good communication between these facilities will be vital to ensure efficient and timely transfer of drugs in short supply. A network of health facilities with an efficient communication system and logistic arrangement is more likely to survive drug shortages than those operating in a silo. MIMS
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Fox ER, Birt A, James KB, Kokko H, Salverson S, Soflin DL, Hawkins B. ASHP guidelines on managing drug product shortages in hospitals and health systems. Am J Heal Pharm. 2009;66(15):1399–406.
Ventola CL. The drug shortage crisis in the United States: causes, impact, and management strategies. P T. 2011;36(11):740–57.