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Transforming How Hospitals Identify and Manage Drug Shortages

Transforming How Hospitals Identify and Manage Drug Shortages

By Patrick Yoder, PharmD, co-founder and CEO, LogicStream Health.

Thermometer, Headache, Pain, Pills

Prescription drug shortages are an epidemic across the U.S health care system. According to the U.S. Food and Drug Administration (FDA), shortages continue to increase. They have grown more persistent and long-lasting (some active drug shortages have lasted for more than eight years), and the intensity of shortages remains high. So do the effects.

Drug shortages create serious negative impacts on patient care. Shortages
of critical or life-saving medications can compromise or delay medical
procedures. They can also cause medication errors and patient harm, according
to the American Society of Health-System Pharmacists (ASHP). A survey
conducted by the Institute for Safe Medicine Practices (ISMP)
2017 revealed that 71 percent of respondents were unable to provide patients
with a recommended drug. Seventy-five percent also stated that patient
treatments had been delayed due to drug shortages, and 21 percent were aware of
at least one medication error related to a drug shortage in the six months
leading up to the survey. A more recent study
from Vizient
found that 38 percent of respondents said that at least one of
the medication errors they recorded from July 2018-December 2018 were
related to a drug shortage.

Drug shortages also contribute to higher costs due to changes in hospital
inventory control practices, the use of more expensive alternative medications
and added labor costs related to shortage management. The Annals of Internal
Medicine reported that prescription drug shortages cause an estimated $230
million in additional costs each year because of the rising prices of drugs
under shortage and the higher costs of substitute drugs. Labor costs, according
to the Vizient report, cost U.S. hospitals at least $359 million a year.

Drug shortage drivers

While quality and manufacturing issues are the most common cause of drug
shortages, consolidation among manufacturers, intermittent lack of raw
materials, recalls, regulatory enforcement, product discontinuations and
natural disasters all play a role. Spikes in demand caused by changes in
therapeutic guidelines, new indications and rapid disease progression also
drive spikes in drug utilization that can lead to shortages.

Strategies for managing shortages

While hospital systems cannot prevent the larger issues leading to
shortages and escalating pharmaceutical prices, they can control how they
prepare for and respond to shortages. The first step is awareness. Hospitals
that receive earlier notification of shortages have an advantage because they
have more time to find additional supply before the amount on hand is depleted.

Once alerted to a shortage, clinical pharmacy teams need to act fast so
they can protect limited supplies of life-saving drugs for critical patients, provide
guidance about accurate dosing for alternative medications and implement
temporary guidelines and usage restrictions during a shortage. In order to
implement those strategies effectively, clinical teams need timely information
about how much of the medication is available, as well as visibility into
ordering, prescribing and dispensing practices.

Technology solutions

Health systems often rely on manual methods of tracking, calculation and
communication, including spreadsheets and whiteboards, and piecing together
that information without the right technology solutions is time consuming and
costly. Finding clinically appropriate alternatives/substitutions, balancing
shortages with other clinical priorities and communicating the shortage to
clinicians all take time and resources. This manual approach also increases the
risk of error and drives up personnel costs required to manage the multiple
pharmacy automation systems and electronic health record (EHR) system changes
that must be adjusted in the face of a drug shortage.

What health systems need is a solution that quickly and automatically
assesses inventory and provides clinicians the data and early warning necessary
for making informed decisions, including;

  • How ordering and dispensing trends are impacting
    current supply
  • All workflows in the EHR driving usage of the
  • Common clinical indications for the drug
  • Which clinicians are ordering, prescribing and
    dispensing medication, including individual top users and departments or
    individual hospitals with highest use

One solution that helps hospitals mitigate the impact of shortages and
manage them more efficiently when they can’t be avoided is The
Drug Shortage App from LogicStream Health™
This solution alerts hospitals to shortages and helps them manage inventory
levels, minimizes disruptions to patient care and controls costs by providing all
the data and insights in the list above.

The Drug Shortage App allows clinicians to access the data they need and adjust
their computer systems without requesting time-consuming reports from IT and
informatics teams. Hospital pharmacy teams can efficiently determine and manage
the clinical and financial risk associated with a drug shortage without
additional support from IT because temporary guidelines and restrictions can be
quickly implemented to EHR workflows and tracked within the app ? and just as
easily undone when the shortage has passed.

The app’s algorithm tracks shortages and automatically calculates the
impact for each hospital or health system based on available inventory and
ordering patterns. For a health system with eight to 10 hospitals, our
customers tell us they’re saving upwards of two FTEs since they no longer have
to scour external websites for shortage data and match up that information with
internal data. These and other

Macro-level fixes

What can be done to reduce the threat of drug shortages? Increasing
competition, expanding manufacturing capabilities and taking legislative action
all have been suggested and debated as potential long-term, macro-level
approaches for curbing the problem. In the short term, hospital systems with
solutions in place to efficiently manage shortages are best positioned to
minimize the impact on patients, staff and financial viability.

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