Electronic Health Reporter

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

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) in 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 medication
• 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.

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.