Evaluate processes
Each institution and professional must re-think how they do things.  Reflect how each one responds to the challenges imposed from disruptions in access. Reveal what has and is being done and then take action. Determine whether the institution has an essential medicines list.(1-2) Evaluate what information is available and what is still needed. What safeguards is one putting in place to ensure patients receive appropriate, quality care during a shortage?  Create strategies to address current issues, as well as strategies to prevent and manage future disruptions. By doing this, more efficient strategies – ones that may even reduce cost, time, effort, and staffing requirements – may be created.

Create practice guidelines, contingency and risk management plans
Numerous organizations and individuals have echoed the need for detailed practice guidelines, contingency, and risk management plans.(1-5) The plans should outline situations that entail the operations during and post a pandemic. Institutions should determine how they will react when processes resume or medication(s) become available. Are they setting up the infrastructure/preparing for a post-COVID?  Revisit the existing guidelines (if they exist) or create new ones moving forward. Business models across the supply chain may change in the coming months and years.

Evaluate workforce utilization and discover new strategies to optimize output and reduce burnout
Management of drug shortages requires a collaborative effort by different professionals within health facilities.  It is fundamental to take a proactive approach to drug shortage management by forming a multi-disciplinary team and creating policies and standard operating procedures to streamline processes. Seek resources and incorporate practices within institutions to reduce workforce burnout.(6)

To foster sustainable innovation, engage with diverse stakeholders and leverage technology.

Greater emphasis on technology and a drive for innovation
In times of urgency, technology can be leveraged in new or enhanced ways to improve access and efficiency, partner with diverse stakeholders, and generate greater information. Innovation is fundamental.  Evaluate how the institution thinks about adaptability, agility, and flexibility within the supply chain.

Engaging diverse stakeholders
No one operates in a silo – so, what does that mean moving forward? The pharmaceutical supply chain includes numerous diverse stakeholders. The questions will continue to be:  what can organizations or regulatory bodies require of each in the supply chain, and how does one regulate or enforce such a strategy? How can all the different stakeholders work together to ensure a reliable, safe, quality drug supply chain?  Leveraging expertise, perspectives, innovation & technology from various disciplines is integral to addressing these medication issues.

The issue and the solution to accessing medications is multidisciplinary. Management of drug shortages requires a collaborative effort by different professionals within health facilities and across industries and countries. Continue to seek insight from the different professionals often impacted by disruptions in supplies within the health facilities in order to assess the practical on-the-ground efforts by institutions to manage drug shortages. Create new partnerships to tackle the issue, whether it is institution-specific, community-based, or nationally. Identify not only each stakeholder incentives but our collective incentives as well. There is a need to support one another. Does it take something as substantial as a pandemic to create such a collective incentive structure?

By having better policies and information-sharing, institutions and professionals will be better equipped to create initiatives and/or safeguards that target the most pressing issues.

Reevaluate regulations and advocate to create policies
Evaluate the current policies and regulations that are affecting the supply chain. Join the conversation and advocate to reduce barriers and improve access.

Be a part of information sharing – from tracking, reporting, and surveillance
Evaluate whether the existing systems are set up to document the impact of shortages and policy changes on patient outcomes and health systems. Each institution should be able to summarize how health facility elements interrelate to ensure patients receive the necessary medications during various stages of care.

If possible, institutions should begin to set up the infrastructure to monitor and quantify the following:

• Number and types of shortages experienced at the institutions

• Resources available to manage drug shortages

• Human resources required at each institution to manage drug shortages

• Cost implication of the drug shortages on the health institution

• Patient and medication safety implication of  drug shortages in the institution

• Cost and burden of drug shortages on the patients

• Identify risk points and flags within system processes that affect access to medications.

Data generated will assist institutions in identifying frameworks, processes, and resources to appropriately and effectively manage drug shortages or any disruption at their institution and improve the patient experience. By having this information, institutions and professionals will be better equipped to create initiatives and/or safeguards that target the most pressing issues. As efforts are being made to increase access to care, all stakeholders need to work to ensure all elements of access are addressed, particularly the element of accessing medications. The emphasis on understanding barriers and processes in accessing medications and managing drug shortages will also allow for improved quality, reduced cost, improved safety, and better health outcomes.

Early detection, predictions, or projections of disruptions in supply chains are critical. Agencies, such as the FDA, have called for improved data sharing and are requiring more accurate supply chain information to accelerate more precise and timely monitoring and assist with identifying disruptions in the supply chain that could lead to shortages.(7)