How Can Infusion Centers Minimize Patient Disruptions During Chemotherapy Shortages?

In this interview with Pharmacy Times, Donna Berizzi, DNP, RN, OCN, NEA-BC, associate chief nursing officer of the Cancer Service Line at Johns Hopkins Medicine, discusses how infusion centers can adjust scheduling and treatment plans during chemotherapy shortages while minimizing disruptions for patients. Berizzi emphasizes that planning must account for drug availability, pharmacy workflows, staffing, chair capacity, patient readiness, and clinical treatment priorities. Advance verification and drug preparation can help teams identify affected patients early, reduce wait times, and preserve treatment continuity. She also highlights how AI-enabled forecasting and coordination across cancer service line locations can help organizations redistribute medications, capacity, and patients based on clinical need and resource availability.

Pharmacy Times: When chemotherapy shortages occur, how can infusion centers adjust scheduling and treatment plans while minimizing disruptions for patients?

Donna Berizzi, DNP, RN, OCN, NEA-BC: I think this is a really important question, and there are a couple of aspects to the answer. We need to look beyond chair space and scheduling. Infusion schedules are only realistic when they reflect both capacity and the resources of the entire team, including drug availability and pharmacy capacity.

This cannot be solely a nursing review of which drugs are back-ordered or may be affected by current or future shortages. Infusion centers need early, real-time visibility into patient readiness, treatment priorities, drug availability, chair capacity, expected demand, and pharmacy workflows. We often look at these issues through our own lens, such as the nursing lens, but we cannot do that in oncology—especially in the ambulatory setting. When we work together as a multidisciplinary team, we can identify constraints, make coordinated decisions before patients arrive, and prioritize those with greater or more urgent needs.

When managing drug shortages, it is also important to have a verification process. Our verification process begins almost a week before patients arrive, giving us an opportunity to identify how many patients may be affected by a shortage. We then work closely with our pharmacy partners to determine whether patients can be moved to another location or whether the drug can be obtained elsewhere. At key sites, this approach contributed to an increase in advanced drug preparation from 9% in 2015 to 65% in 2024. Verification involves more than verifying the drug; we also premix certain drugs when appropriate so that they are available to patients in a timely manner. This reduces wait times and helps us determine whether a patient should be moved from the beginning of the week to later in the week based on anticipated needs.

Successfully managing chemotherapy shortages requires more than finding another appointment time. Integrated clinical and operational responses are essential, and these efforts should involve the entire cancer service line. Not every cancer service line can currently operate this way because some are not yet equipped to view operations from a broader perspective. At Johns Hopkins, for example, we consider not only the hospital but all the sites within our cancer service line.

The goal is to make the best possible use of our capacity and resources, including both medications and staffing. We need to ensure that the right patient is treated at the right time and in the right location. When oncology sites operate as one coordinated system, they can look beyond the resources of an individual infusion center and manage drug supply, pharmacy capacity, infusion capacity, and patient demand across the broader scope of oncology care delivery.

Limited products should be redistributed to the locations where patient demand is greatest. For example, when we experience a drug shortage, we immediately hold a huddle that includes all our sites. We determine where most patients who require that drug are located. We can then either move patients to a particular site or identify a location that has the drug and can send it to our downtown site.

This approach highlights the use of artificial intelligence (AI), verification processes, multidisciplinary teamwork, and the cancer service line. Pharmacy teams, nurses, clinicians, scheduling teams, and operational leaders all need to share a view of their operations. They need to know where shortages exist, whether patients are ready for treatment, what the clinical treatment needs are, and what delays are expected based on the site of care.

When this information is combined with AI-enabled scheduling and forecasting through a company such as LeanTaaS, teams have greater visibility into anticipated demand during a drug shortage. This visibility can help identify where limited medications will be needed and allow leaders to coordinate care across sites.

This is where the cancer service line becomes particularly valuable. Instead of managing a shortage only from the perspective of The Johns Hopkins Hospital, I can contact all our other cancer care sites and ask, ‘Do you have the drug, or do you have the capacity to accept patients?’ We also consider patient-specific circumstances and ask, ‘Can the patient travel to one of our other sites?’ Most of our sites are relatively close, except for one in Washington, DC, so we have considerable capacity to balance patient care, reduce drug waste, protect treatment continuity, and maintain appropriate pharmacy oversight and clinical prioritization.

Ultimately, managing chemotherapy shortages is not simply a scheduling issue. It is a pharmacy issue, a nursing issue, an operational issue, and a workflow issue. It is therefore important to approach it from the broader perspective of the cancer service line.