4/23/2012
Objectives Surviving the Shortage: A Collaborative Approach to Managing Drug Shortages
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Describe the impact drug shortages have on healthsystem Pharmacy resources.
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Discuss the sequence of events that influenced a multi-hospital health system to adopt a collaborative model for management of drug shortages.
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Review the structure of a collaborative process model for the management of drug shortages.
Lorrie Burns, Pharm.D. Medication Safety Pharmacist Riverside Methodist Hospital- OhioHealth
Kelly Besco, Pharm.D., FISMP Medication Safety Coordinator OhioHealth Pharmacy Services
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Impact of Drug Shortages
Impact of Drug Shortages
What needs to be done?
What needs to be done?
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Identify the shortage! Identify alternative products or therapeutically equivalent agents Communicate (often!) with manufacturers or wholesalers Educate healthcare professionals about alternatives Develop or modify policies or guidelines
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Collaborate, strategize, implement
Oh, and how about those other job responsibilities you might have…..
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Impact of drug shortages on U.S. Health-Systems
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Impact of Drug Shortages - Time
Survey sent to 1322 ASHP members identified as Directors of Pharmacy 10-11/2010 Examined four domains: –
Demographics
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Impact of recent drug shortages (30 agents)
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Resource utilization to handle shortages –
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Update pharmacy computer systems and other electronic databases Move inventory within the institution(s) Call together important stakeholders when drug supply cannot meet clinical need
Hospital Characteristics
Identify the shortage, determine alternatives, manage inventory, communicate to healthcare staff, update databases
Median hours/week Pharmacists (Interquartile range)
Median hours/week Pharmacy Technicians (Interquartile range) 8 (3-17)
Overall
9 (5-20)
400 beds
12 (8-28.5)
13 (6-21)
Adequacy of current drug shortage information sites
Kaakeh R, Sweet BV et. al. Impact of drug shortages on U.S. health systems. AJHP 2011;68:e13-21.
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AJHP 2011;68:e13-21.
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Impact of Drug Shortages - Cost
Impact of Drug Shortages
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Hospital Size
Median Annual Labor Cost Pharmacists (Interquartile range)
Median Annual Labor Cost Pharmacy Technicians (Interquartile range)
< 100 beds
21,753 (13,595-33,989)
3,520 (1,408-7,745)
100-199 beds
24,472 (13,595-53,702)
6,337 (2,112-12,321)
200-399 beds
24,472 (13,595-74,775)
7,041 (3,520-14,082)
>400 beds
32,629 (21,753-77,494)
9,153 (4,225-14,786)
AJHP 2011;68:e13-21.
Estimated annual cost of managing drug shortages applied to national health-systems:
$216 million ($114-483.1 million) 8
AJHP 2011;68:e13-21.
Every story has a beginning… OhioHealth Pharmacy Services
Sole US Supplier: – – – –
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Potassium Phosphate Electrolyte Products Trace Element Products Zinc Sulfate
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Advantages
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Divide and Conquer: Streamlined Resources Internal Supply of Product Preserved –
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– Determined inventory threshold for
30 mMol phosphate provided daily in PN
activating
strategies
Measured use of pre-made solution of PN from May 3June 3 at 4 hospitals –
System-wide pharmacy team met weekly to evaluate internal inventory of electrolytes. – Developed additional conservation strategies
Example: Parenteral Nutrition (PN) –
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Post-Intervention:
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40 Patients Ordered PN = 228 PN Therapy Days
Additional Interventions: – Sharing of Inventory/Allocations
– 6,840 mMols of Phosphate Conserved
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Neonatal PN preparation consolidation
– Equivalent to: 456 vials of Phosphate, 5 mL
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Limit MVI to Mon, Wed, Fri when appropriate
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Discouraged use of PPN
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Pilot Project
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Feedback that shared process was invaluable, especially for the smaller facilities. Pilot project: 1. 2.
Shortage identified by a facility Notice forwarded to a rotating pharmacist/clinical lead –
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Initially Medication Safety Coordinator
Pharmacist lead disseminated notification of shortage across sites Email group created on email server
Site assigned to develop a conservation plan; once developed disseminated across sites 18
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Pilot Project: Experience • Model was effective for addressing critical shortages. –
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However, not practical to develop a conservation plan for every national shortage.
Overall need to develop tracking process for: –
Newly reported shortages
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Trends in availability
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Resolving shortages
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Shortage Tracking Tool
Shortage Tracking Tool: Experience
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Available inventory tracked weekly for drugs with limited inventory. Spreadsheet featuring ALL national shortages.
Weekly summary distributed to Shortage Team.
• Available inventory tracked monthly for drugs with adequate inventory.
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Allowed for earlier identification of shortages impacting our supply chain. In turn provided additional time to develop conservation protocols.
Resource intensive –
Estimated 4 hours per week spent on updates.
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Not practical process to maintain in the long term without additional assistance.
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Shortage Tracking Tool: Improvements • Transitioned content of spreadsheet to Access Database
Drug Shortage Intranet Site
that maps to Intranet website. –
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Additionally added attributes of individual hospital developed websites
Over 200 drugs featured
Pharmacy Data Analysts oriented to tracking process and assigned to complete weekly updates. Wholesaler Market Shortage (i.e., “Omit”) report added to tracking process. –
Analysts screen report for items not listed on external websites.
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Allows for further investigation and identification of new shortages.
Weekly wholesaler supply updates for trending
Ability to attach supporting documents
Inventory monitored weekly for Critical shortages 24
Links to National updates
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Drug Shortage Intranet Site
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Drug Shortage Intranet Site
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Current Process • Drug Shortage Team meets weekly
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½ hour weekly teleconference
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Members include Pharmacists, Procurement Coordinators and Data Analysts
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Facilitated by Medication Safety Coordinator
Drug Shortage Response Team •
Standing Agenda: –
Critical Shortage Review – – – –
2011 ISMP CHEERS Award Recipient
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Worsening Shortages
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New Shortages
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Procurement Coordinator feedback drug availability New ASHP/FDA shortages Shortages identified from Market Shortage Report
Resolved Shortages –
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Available Wholesaler Inventory Site Inventory Review National Updates Conservation Planning
Resolved Shortages reviewed monthly and removed from website
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Lessons Learned • Grey Market Suppliers – –
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Lessons Learned: Allocations
Policy to prohibit procurement via Grey Market Suppliers Opened account with a secondary wholesaler
Allocations Notification/Identification Available procurement quantities vary based on purchase history – Weekly wholesaler allocation report – –
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Communication –
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Challenges in reaching physicians 30
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Link to Drug Shortage Information on front page of Intranet
Critical Drug Shortage Information
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Surviving the Shortage
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Concluding thoughts: –
Utilize all available shortage websites to keep up to date.
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Watch for wholesaler market shortages to identify trends and new shortages.
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Collaborate with prescribers and stakeholders to strategize on alternative therapies.
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Create an internal database, if possible, for healthcare personnel to refer to for shortage information.
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Communicate, communicate, communicate!
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Lorrie Burns, Pharm.D. Medication Safety Pharmacist Riverside Methodist Hospital- OhioHealth
[email protected]
Kelly Besco, Pharm.D., FISMP Medication Safety Coordinator OhioHealth
[email protected]
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