Hospitals employ several strategies for a proactive approach to shortages.
Due to a variety of new communication and technology advances, pharmacists now are much better armed to prevent drug shortages. During the initial surge of the COVID-19 pandemic in April 2020, severe drug shortages plagued health systems. Particularly affected was the supply of sedation medications. However, this was not the case during the second surge this winter, according to Emily Pherson, PharmD, assistant director of medication use policy and clinical informatics at The Johns Hopkins Hospital in Baltimore, Maryland. “In this second surge, we are doing much better than back in the spring,” Pherson told Drug Topics®.
Chronic drug shortages have become a much bigger issue in recent years. However, Michael Ganio, PharmD, MS, BCPS, FASHP, senior director of pharmacy practice and quality for the American Society of Health-System Pharmacists (ASHP) in Bethesda, Maryland, said pharmacists now have better software technology for managing inventory control. Typically in hospitals there are seasonal changes, with more respiratory infections in the winter and a greater need for antibiotics. However, centralized inventory allows a pharmacist to better keep track of how specific drugs are being prescribed. This can allow for an immediate alert if a drug is in short supply or headed that way. “The most major thing is communication,” Ganio said, “everything from the purchasers, who may have an early signal that a shortage is going to occur, and then notifying the clinical pharmacist and the providers.”
The COVID-19 pandemic created drug shortages that had not been anticipated. Ganio said in April and May 2020, pharmacists experienced a 300% to 500% increase in the use of intensive care drugs and agents for patients on ventilators. “So the whole country was affected because wholesalers made big shifts,” Ganio said. “That was a very scary time for the pharmacists.”
Artificial intelligence (AI) could be potentially useful in helping prevent drug shortages. However, limitations exist due to the inability of AI to predict a problem at a manufacturing plant or other links in the system. “When it comes down to it, there is not a lot of transparency,” Ganio said.
Most drug shortages are caused by manufacturing quality issues.1 There may be a quality issue identified during an FDA inspection, but the citation may not be posted in a timely matter. “It could be glass, the raw material, or a supply chain issue,” Ganio said. Warning letters can be delayed for months, he noted. AI use may be limited due to these factors and the fact that third parties are involved and often masked.
New drug shortages in general are declining, but the concern among pharmacists is that hundreds of drugs remain in chronic shortage. To address this issue at The Johns Hopkins Hospital, there are weekly task force meetings looking at all drug inventories and stocking practices. One task force examines weekly inventories and the areas of highest need. A second task force is dedicated solely to COVID-19–related treatments. Combined with other strategies, such as analytics solutions, pharmacists work with the providers to restrict drugs to those who are in the most need so each agent can be used the most optimally. “The keys are good management and use of dashboards that can allow for easily pulling data for monitoring and predicting shortages,” Pherson said. “It lets you be more proactive.”