Managing medication shortages: The pharmacist’s role

During the recent International Pharmaceutical Federation (FIP) Congress in Bangkok, Thailand, one session I attended delved into the topic of medication shortages. These shortages can result in hefty financial losses for the healthcare sector. It has been estimated that medication shortages led to an increase in labor costs in the United States of more than $200 million in 2011. As this subject has grown in significance over the past few years, I was hoping to gain a greater understanding of the underlying issues by attending this discussion.

The presentation by Sherry Peister, BS Pharm, former president of the Canadian Pharmacists Association, began by acknowledging that while medication shortages are not a new phenomenon, they have increased in frequency over the past four years. With a complex global supply chain and sourcing in India and China for most of the raw material needed to manufacture the active ingredients of medications, any number of disruptions can lead to medication shortages.

The issues

So what are some of the issues that can affect the supply chain or otherwise lead to a shortage of medication?

First and foremost, increased demand around the globe has put stress on production. With the continued emergence of markets in Brazil, China, India, and Russia leading the charge, demand is greater than ever before.

In addition, increased regulation and inspection of manufacturing facilities has led to stoppages in production.

National stockpiling of “disaster” medications can create public shortages, as was the case with Tamiflu in recent years in response to threats of avian influenza.

Natural disasters have wrought havoc on some manufacturing facilities, resulting in delays with production.

And finally, shortages can also result from a lack of communication between nations about the medication supply. Without reliable information, drug shortages can be difficult to predict and challenging to address.

Increasing rates of shortages mean many hospitals are operating in crisis mode with their medication supply chain. In a sense, management of medication shortages is similar to disaster management, as available supplies are used while future demands are determined, and adaptation occurs as needed. Every day, in hospitals and community locations across the country, pharmacists must manage these shortages in an effort to minimize the impact on patients.

Assessment

Douglas Scheckelhoff, MS, vice president of Practice Advancement, ASHP, also presented on the topic, with an overview of the role pharmacists play in managing medication shortages.

He began by detailing some of the problems that result from these shortages. Shortages can result in an increase in medication errors, particularly in connection with chemotherapeutics and opioid agents. Depending on the type of medication, delays or alternative treatments could be life-threatening. Having a plan in place to account for shortages is essential to providing the best patient care.

Scheckelhoff provided an assessment strategy for pharmacies dealing with potential shortages. The initial phase involves determination of which medications are being shorted, identification of current stock counts, and verification of how long the current stock will last.

Next comes a clinical assessment, to determine whether therapeutic alternatives exist and to decide what the impact will be on patients in terms of both outcome and safety.

Action

It is also important to have a communication strategy for the healthcare team, so that all parties know what drug products are affected and why they are being shorted, as well as how long the shortage is expected to last.

Managing these situations requires flexibility and creativity on the part of both the prescriber and the pharmacist. Also, necessary are speed and attention to detail. Lastly, advanced planning and communication are critical to handling medication shortages.

Ultimately the pharmacist’s role is to minimize the impact medication shortages will have on patients. By staying up to date, developing management strategies, and recommending evidence-based alternatives, pharmacists can provide patients with safer, more timely treatment. As with most things in life, open communication and having a plan of action in place are essential to optimal outcomes.

A frequent contributor to Drug Topics, Joel Claycomb specializes in reports from far-flung locations. Contact him at jcclaycomb@gmail.com.