Ten Obstacles Faced During a Drug Shortage
The drug shortage crisis isn’t slowing down or disappearing in the near future.
Various stakeholders face numerous obstacles on their quest to obtain a needed medication during a drug shortage. Drug shortages of essential drugs are becoming increasingly prevalent and are considered a public health crisis across the globe. The presence of drug shortages significantly threatens universal efforts to increase access to safe and quality care and has considerably increased costs of care. The implications of drug shortages are felt across the board, affecting all elements of health systems and facilities – as well as patients and their families.
In a Fireside Chat, Dr. Rola Kaakeh provided thought leadership on the drug shortage crisis and the obstacles faced by the diverse stakeholders on the frontlines during a shortage. The session brought together a diverse audience of professionals. To listen to the recording, click here. Below are the ten obstacles. It is important to note that these are not a cumulative, all exclusive list – but rather major themes that exist and were discussed during the session.
1 - Being unprepared
A common frustration experienced by diverse stakeholders across the board is the feeling of being unprepared. This is coupled with multiple other obstacles and is a theme that negatively impacts patient care and increases costs.
2 - Increased workload and disruptions in operations
Drug shortages management consumes a significant amount of personnel time – e.g., time of pharmacists, pharmacy technicians, physicians, and nurses, among many others. Management of drug shortages takes the time and energy of these professionals away from high-value activities, like patient care. Institutions have had to build their capacity to manage disruptions, expand their teams, and cross-train existing staff. For some, their current workforce isn’t enough. Several institutions have had to hire additional staff exclusively to manage drug shortages. Management is also often reactive, rather than proactive.
Even pre-COVID, any disruptions in the supply chain lead to a significant increase in workforce time and effort. Drug shortages during a pandemic only add to the workforce burden. Situations of crises have also impacted workforce capabilities. We have seen a drastic reduction in the workforce across the globe, as facilities have shut down due to social distancing measures. All the diverse individuals responding to crises are affected – e.g., individuals who work at the various facilities in the supply chain to those who work in all the healthcare facilities that dispense or administer medications. Of course, workforce burnout also remains a significant concern.
3 - Gaps in information
The quality of the existing data is poor and insufficient to manage the crises. There is a lack of complete publicly available information regarding resupply dates, reasons for shortages, location of raw materials and manufacturing facilities, and many other items. This has been an ongoing issue throughout the years. Health systems are often not given clear definitive end dates or resolution dates. There are numerous reasons for disruptions of the supply chain, but often no reason is given at all, which is extremely frustrating.
There is the continuous debate of “too little or too much information.” Some are concerned that sharing of “too much information” can potentially lead to shortages and price gouging. This is why it’s essential to work towards identifying the “right” information. Consistently we’ve advocated for more information. The more information we have, the more we can do. The availability and usability of complete information remain a significant concern.
4 - Time: the need for speed
In healthcare, we prioritize our efforts to ensure we have the right medicine for the right patient at the right time. There is an urgency associated with administering or providing many medications, particularly in the case of a pandemic. We need to plan and make decisions quickly – there is a particular “speed” at which we have to make decisions. Overall, we need to keep in mind how much time things take when having to manage crises.
5 - Hoarding of medications, leaving others without
In general, stockpiling and hoarding reduce the amount of medications available for others to obtain. This could accelerate the occurrence of a potential drug shortage. More considerable attention and evaluation are needed to determine the impact of stockpiling on access to medications across geographies.
6 - Implementing rationing practices
Due to limited availability, many have felt uncomfortable implementing rationing practices at their institution. A number of healthcare staff have reported rationing or restricting medications in short supply.
7 - Safety concerns
Medication Safety Concerns
As suppliers and manufacturers rapidly change due to closures, new and existing restrictions, and shortages begin to impact access, we have and will continue to see an emergence of unregulated supply chains. We are left with a limited number of sources and concerns of quality, reliability, and safety linger. The current vulnerable environment and the introduction of these unregulated supply chains become breeding grounds for the introduction of adulterated and falsified medications.
Patient Safety Concerns
Professionals have noted the unsafe environments caused by drug shortages, resulting in medication errors, near-misses, and potentially adverse effects. This is due to a vulnerable environment where providers (physicians, nurses, pharmacists) prescribing, verifying and administering unfamiliar agents, miscommunication of updated protocols, little guidance, miscalculations, etc. – all impacting patient safety.
8 - Negative impact on patient care
Providers have reported not being able to provide recommended drug or treatment, the use of sub-optimal alternative therapies, using agents they are less familiar with, and an overall limited number of treatment options. The problem needs to be addressed urgently, especially for critical medicines, to avoid any negative impact on patient care. Medication continuity is also a concern – particularly in patients with chronic conditions. One of the attendees noted that without continuity of care, it could worsen morbidity and mortality associated with chronic conditions that rely on continuous access to medications. Professionals have also expressed discomfort in having the difficult but necessary conversations with patients when they can’t provide them the medications they need.
9 - Costs
Drug shortages have also resulted in noteworthy increases in costs to all stakeholders in healthcare. There are substantial costs associated with obtaining medication and costly alternatives, as well as costs related to the time required to manage drug shortages. These, alone, account for hundreds of millions a year.
10 - Uncertainty
Things are constantly changing – by the day, hour, and minute. The need to continuously plan, update, and make decisions during uncertainty is frustrating for many. Each decision has a ripple effect on access, whether positive or negative. It’s critical to understand the decision-making process of each institution and the risk associated with each decision.
Professionals must be better equipped and given the tools and methods to manage and respond to drug shortages adequately.
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