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Medicine shortages in the hospital setting: analysis of the trend in five Italian centres during the three waves of the SARS-CoV-2 pandemic
  1. Ludovica Mazzoleni1,2,
  2. Andrea Zovi1,2,
  3. Cecilia Borsino1,
  4. Cinzia D'Angelo1
  1. 1UOC Farmacia, ASST Santi Paolo e Carlo, Milano, Italy
  2. 2Department of Pharmaceutical Sciences, Università degli Studi di Milano, Milano, Italy
  1. Correspondence to Dr Ludovica Mazzoleni, UOC Farmacia, ASST Santi Paolo e Carlo, 20142 Milano, Italy; lmazzo2004{at}

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In recent years the phenomenon of medicine shortages has increased worldwide, resulting in serious difficulties for healthcare professionals in ensuring access to treatment for patients.1 2 During the SARS-CoV-2 pandemic, the phenomenon was further exacerbated by the massive consumption of specific medicines with consequent shortages due to production-related problems.3 The issue has been addressed by identifying overlapping alternative therapies, or by importation or even by making extemporaneous substitute preparations.4 At the centres run by our regional health authority (two hospitals and three prisons), an analysis was conducted to assess the trend in the phenomenon in the three waves of the pandemic, considering medicines included in the therapeutic formulary (TF). The aim of the research was to determine the daily impact of the shortages on clinical practice and on the work of hospital pharmacists, and the development of further preventive strategies used to counter it.

The analysis considered all TF medicines found to be temporarily lacking during the three waves of the SARS-CoV-2 peak prevalence: March–May 2020 (T1), October–December 2020 (T2) and February–April 2021 (T3). Reminder requests to suppliers sent by the hospital pharmacist, communications sent to the wards reporting deficiencies and import requests were consulted. Overall, 58 different TF medicines were found to be lacking (30 cases in T1, 24 in T2 and 25 in T3), 23 of which were due to large consumption in COVID-19 wards, as shown in table 1. In the case of 16 of the 58 total medicines, the shortage generated in a single wave was repeated in the following waves: six medicines were found to be lacking in T1 and T2, three in T1 and T3, two in T2 and T3 and five in T1, T2 and T3. However, it is noteworthy that the recurrence of shortages was not always due to the pandemic; indeed, for 15 active ingredients administered in patients affected by the virus, the shortage which occurred during one wave was not repeated. On the other hand, the following eight active ingredients were found to be repeatedly lacking due to a high level of consumption in patients with COVID-19: heparin sodium, omeprazole, propofol, tocilizumab, remifentanil, rocuronium, dexmedetomidine and cisatracurium. Overall, medicine shortages decreased in the centres during the three waves, falling by 20% from the first to the second wave and settling down between the second and third waves, showing how preventive measures of rationalisation of consumption adopted after the first wave avoided further shortages. However, 13.7% of lacking medicines, including important life-saving medications, were clearly affected by the pandemic, being repeatedly unavailable over the three waves due to their continued use in patients with COVID-19. Currently, the course of the pandemic is not predictable and there is a lack of studies in the literature comparing cases of shortages in different waves. It is hoped that this analysis may provide a basis for developing strategies aimed at preventing future shortages in our centres, in order to improve work processes and planning and further raise awareness among healthcare professionals to avoid a negative impact on patient health and an increased workload on the hospital pharmacist.

Table 1

List of medicines lacking in the three waves of the COVID-19 pandemic (T1, T2 and T3)

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  • Author Contributions: Ludovica Mazzoleni (L.M.), Andrea Zovi (A.Z.), Cecilia Borsino (C.B.), Cinzia D'Angelo (C.D.) Conceptualization, L.M. and A.Z.; methodology, A.Z.; investigation, L.M. and A.Z.; writing—original draft preparation, L.M. and A.Z.; writing—review and editing, A.Z. and C.D.; visualization, C.B. and C.D.; supervision, C.D. All authors have read and agreed to the published version of the manuscript.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; internally peer reviewed.

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