Background Drug tenders and shortages result in drug changes and may result in discrepancies between prescriptions and available drugs. A high requirement for drug substitution (generic and therapeutic) may pose a potential patient safety risk. Little is known about how nurses manage such challenges.

Purpose To investigate how drug substitution due to drug changes and discrepancies between prescriptions and available drugs are managed by nurses. A secondary aim was to document time spent by nurses to address these challenges.

Material and methods The study was designed as a cross-sectional survey. Data were collected from a paediatric (45-bed) and a medical (33-bed) ward at a Danish public hospital. A structured self-reporting form was used for data collection. All nurses on the two wards were invited to record any problem requiring drug substitution together with a time estimate. Data were collected during May and June 2014.

Results A total of 38 responses was obtained from which 2 were excluded. Eighteen responses were related to drug tender, two to drug shortages and 16 to other reasons including physicians failing to prescribe within the ward drug list. Nurses used different strategies to manage drug substitution. In 20 of the cases, a different drug from the one prescribed was dispensed. Other strategies included contact with a colleague, contact with the pharmacy, request for a new prescription and obtaining the drug from another department. On average, the nurses spent 7 min on each response. Two cases concerned non-registered drugs and both nurses reported requiring 35 min to solve the problem.

Conclusion Nurses use a variety of strategies to manage drug substitution. Direct generic or therapeutic substitutions were the most common strategies. In all cases nurses spend extra time managing the substitutions. Improved implementation of drug changes and focus on correct prescribing may indeed improve the safety of the medication process and reduce the time spent on drug dispensing.

References and/or acknowledgements No conflict of interest.