A presentation given by Matthew Grissinger, RPh, FISMP, FASCP, at AMCP Nexus 2019 highlighted continued drug shortages and how they compromise patient care.
The presentation began with a timeline of drug shortages, beginning with the first Institute for Safe Medicine Practices (ISMP) survey on the impact of drug shortages in 2001. For the second drug shortage survey, given in 2010, one out of four patients reported actual errors. The survey was deployed again during a drug shortage summit in 2014, and again in 2018. Grissinger named several common reasons for drug shortages, including unavailability of drug production materials, production delays in response to an FDA enforcement action, voluntary drug recall, business decisions to stop production, changes in the manufacturer or product composition, mergers narrowing the focus of product lines, natural disasters, inventory ordering practices, and unexpected demand spikes.
Patients are harmed by these shortages, potentially experiencing medication errors, receiving the wrong drug, overdoses, exacerbating disease state, prolonging hospitalization, having the need for critical care, and many other adverse outcomes. Challenges in communications that can lead to drug shortages include keeping up with frequent supply changes, contacting physicians throughout the process, confusion about what is available, and difficulty conveying information to the right people at the right time.
Grissinger proposed the following drug shortage assessment checklist to prevent these negative outcomes associated with drug shortages:
- Verify inventory on hand
- Initiate alert/ communication plan to practitioners
- Begin research on alternatives
- Prioritizing patients who are in greatest need
- Conduct a mini failure mode and effects analysis
- Consider: alternate packaging, different concentrations, therapeutic alternatives
The presentation concluded by noting that drug shortages impact practitioners, patients, decision-making for managed care pharmacists, and many processes associated with medication use, including such as formulary management, prescribing, dispensing, and administering medications.
Grissinger serves as Director of Error Reporting Programs at the Institute for Safe Medication Practices (ISMP).
Grissinger, M. How Continued Drug Shortages Compromise Patient Care. Presented at: AMCP Nexus 2019; October 29 – Nov 1; National Harbor, MD.