Being prepared is vital to understanding and resolving future drug shortages.
It is important for pharmacists to stay informed about ongoing drug shortages and factors that contribute to them, remain proactive in addressing them, and know what alternate resources are available to treat patients.
Identification of a potential drug shortage can be difficult, as there is no single definition of a drug shortage, according to a presentation given at the ECRM's Hospital and Alternative Site Pharmacy EPPS meeting held recently in Braselton, GA. The speakers, Senior Director Joe Maki, Pharm.D., M.S. and Pharmacy Distribution Specialist Brandon Gillis, were from Novant Health.
The FDA and the American Society of Health System Pharmacists (ASHP) have 2 distinct definitions of a drug shortage. The FDA identifies a drug shortage as the period of time when the demand for a drug exceeds the manufacturers ability to produce it, based on information provided by the manufacturer and market sales research. ASHP officials define drug shortages as a shortage of all drug and biologic products that have a national impact. The shortages are verified with the manufacturer, influence the way pharmacists dispense drugs, and result in the use of alternative drugs and, therefore, potential issues in patient care. Due to these 2 distinctions, ASHP often lists more drug shortages than the FDA, according to information from the presentation.
Gillis and Maki discussed several contributors to shortages in recent years, including, severe weather events like the Hurricane Maria earlier this year, which led to a shortage of Puerto Rican-produced IV bags, which hold saline solution. They also noted an increased demand for emergency syringes, electrolyte fluids, local anesthetics, and opiates.
Identifying drug shortages is important in determining how to address them. Pharmacists should communicate with the wholesaler or manufacturer to clarify that no more products are in, according to Gillis. Pharmacists can also take advantage proactive monitoring techniques to identify a shortage, such as inventory management software resources, updates from manufacturer account managers, and other resources like the FDA or ASHP websites. An intranet provider can also be a useful resource to determine what shortages are affecting your facility, he explained.
Gillis discussed a communication tool he described as SBARQ, which stands for: Summarize the situation, Background, Assessment, Recommendations, and Questions to help communicate shortages to staff and to help mitigate the impact of the drug shortage. Switching patients to alternate medications can be one way to achieve this: a survey released by ASHP concluded that 75% of respondents had to switch patients from injectable opioids to oral solids due to shortages in 2017.
Another technique is to determine if drop shipping or direct ordering would be more beneficial for addressing shortages on an individual product. Steps to managing drug shortages include taking a careful inventory to ensure that a minimum order is in stock, ensuring backorders are placed when appropriate, and communicating with the manufacturers and wholesalers.
The presenters drew on their own experiences of addressing opiate shortages. Signals of a potential opiate shortage had been increasing since August 2017, and through monitoring trends, the presenters were able to prepare for a morphine and hydromorphone shortage in November.
Their preparation allowed them to implement a best practice alert to use morphine sparingly, prescribe oral alternatives when possible, and stay updated on the duration and impact of the shortages, according to Dr. Maki.