Background Medicine shortage in hospitals is defined as insufficient patients’ supply, without generic substitution. The particular problem has been reported by both professionals and patients, and acknowledged by European institutions. The cited causes range from production disruptions to trade and distribution factors.
Purpose This study aimed to register medicine shortages in a middle-range general hospital during one year, analyse the causes and correlate them to medicines’ anatomical therapeutic category (ATC) and essential quality.
Material and methods Medicine shortages were reported daily from 1 August 2017 to 31 July 2018 and analysed according to three causes: medicine’s withdrawal (MW); manufacturing/importing problems (M/I); and delayed hospital pharmacy’s response to stock replacement (HPR). Days to restore availability were recorded and categorised in two groups: 1–3 days (automated re-stock) and more than 4 days (pharmacists’ involvement). Shortage cases were also stratified according to ATC. All medicines recorded shortages were classified into five classes using a Modified Essentiality List (MEL)1: 5, 4, 3, 2 and 1, with 5 attached to high priority.
Results Two-hundred and ninety-nine shortage cases were reported concerning 239 medicines. A new shortage case was reported every 1.2 days: 4% concerned MW, 40% M/I and 56% HPR. Average days to restore availability for M/I and HPR were 52 and 11, respectively. For M/I cause, 114 shortage cases (94.21%) needed more than 4 days to restore, while for HPR causes, 97 cases (58.43%). Neurological and cardiovascular regimens’ shortages were first (26%) and second (15%) categories, regardless of cause. For M/I causes, neurological regimens’ shortages were first (21%) and medicines for alimentary track and metabolism second (13%) categories. MEL class 5 comprised 53 cases (18%), including lithium, nitroglycerine, verapamil, loperamide and tuberculin. MEL class 2 comprised 152 (51%) cases.
Conclusion Shortage cases are very often reported to the hospital pharmacy. HPR is the more frequent reason for a shortage case, the quicker to resolve, and demands strong pharmacists’ involvement. For the M/I cause of a shortage, there is a much longer restoration time. The use of MEL classification sets the priority for an efficacious response, especially if combined with local distribution conditions. The re-ordering model of our pharmacy is being reviewed.
Reference and/or acknowledgements
WHO Essential Medicines’ List (March 2017).
Reference and/or acknowledgementsNo conflict of interest.
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