Background and importance Drug shortages can adversely affect drug therapy, compromise or delay medical procedures, result in medication errors and ultimately cause patient harm. Drug shortages also have financial consequences for hospitals, the state and patients. In the Mater Misericordiae University Hospital (MMUH), the medicines information (MI) service collaborates with dispensary, clinical and other colleagues to manage drug shortages. In 2019, drug shortages represented 17% of the MI service workload in contrast with 9% in 2018.
Aim and objectives To review the nature and impact of drug shortages managed by the pharmacy department in 2019.
Material and methods Shortages were logged in MiDatabank with ‘shortage’ as a keyword. Relevant 2019 enquiries were identified. Details for each shortage were collected, categorised and analysed. The procedure for managing drug shortages was reviewed.
Results The pharmacy department managed 403 drug shortages in 2019. Most drug shortages lasted more than 1 month (56%) and were due to manufacturing delays or an unexpected increase in product demand. In most cases no purchasing action was taken as there was sufficient stock to cover the expected shortage duration (n=141; 81%) or because no alternative option was available (n=33; 19%). Apart from purchasing reactions, other actions needed were hospital wide communication (13%), immediate stock rationing (9%) and/or protocol amendments (3%). Drug shortages requiring further follow-up mainly concerned drugs of critical nature (eg, antimicrobials, fentanyl, morphine, lorazepam). 5% (n=22) of drug shortages were due to wholesaler issues. In four of these cases, immediate action was needed (hospital wide communication (n=2) immediate stock rationing (n=2)). Wholesaler shortages do not fall under the accepted European or national definition of a true drug shortage, however, MMUH experience is that these shortages can require similar assessment and treatment as true shortages. The MMUH pharmacy department processes on managing drug shortages were reviewed and streamlined to provide a stepwise approach with individual pharmacy department member roles and responsibilities clearly defined.
Conclusion and relevance Drug shortages are a challenging part of pharmacy service delivery with a significant impact on daily operations. Greater collaboration among all stakeholders is needed in Ireland to enable pharmacy departments to appropriately assess the impact of drug shortages and make practical decisions to ensure continuity of supply for patients.
Conflict of interest No conflict of interest
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