Rapid Response Teams, Tech Tools Help Limit Drug Shortage Damage

Minneapolis—With many critically needed medications in short supply over the past few years, pharmacists are looking at ways to improve how they handle drug shortages. Strategies for managing these scarcities by using informatics and collecting, analyzing and communicating information on medication shortfalls were presented at the American Society of Health-System Pharmacists (ASHP) 2013 Summer Meeting.

“Shortages take a tremendous amount of time and labor to manage,” said Erin Fox, PharmD, the director of the Drug Information Service at the University of Utah Hospitals and Clinics in Salt Lake City, and a noted expert on drug shortages. “It’s helpful to see published results like this on how to more efficiently manage shortages in the real world. It gives organizations ideas they can copy at their own institutions.”


Dealing with drug shortages can be a huge drain on staff resources, noted Charles Burometto Jr., RPh, an information systems pharmacist at Johns Hopkins Hospital, in Baltimore. “It’s certainly taken a big chunk of my time over the past three years.” Indeed, many of the systems changes his team makes each day are related to shortages. “I was talking with my boss about the effort we spend to keep our information systems up to date on shortages,” Mr. Burometto said. “That’s when we decided to look back over a year and put some numbers together.”

There were 50 reported drug shortages that required computer systems to be modified, according to a study he presented at the meeting (24-M). Most of the changes involved adding pop-ups and other messaging tools to alert prescribers about short-supply medications. All told, the staff made 128 systems changes in nine different categories. “I knew we made quite a few system changes,” Mr. Burometto said. “But I didn’t realize it was that many.”

The messaging updates ranged from a simple alert stating that a drug was in short supply, to alerts that actually prevented certain short-supply items from being ordered. “The messages direct prescribers on how to proceed, and when appropriate, suggest alternative medications,” Mr. Burometto explained. “We used to put a note on the item, but physicians would just order it anyway.”

In some cases, very extensive programming changes were needed, he noted. “For example, we had to rewrite some of the logic for how total parenteral nutrition orders are processed, because so many of the options available for the additives are in short supply.”

Mr. Burometto added that all but six of the 50 shortages required a faster turnaround on software updates than usual. (The normal turnaround time is 14 days.) Some of the shortages were so severe that they required an immediate systems change.

Dr. Fox said Mr. Burometto’s informatics research is spot on. “The IT [Information Technology] Department is crucial in managing a shortage. Hospitals have become very automated, with various machinery to track meds. It’s great to have informatics pharmacists on staff who understand the urgency of making changes to the systems.”

Novant Health Approach

A second study (32-M) presented at ASHP described how Novant Health, a 13-facility hospital system in North Carolina, South Carolina and Virginia, developed a strategy for monitoring and quickly responding to drug shortages. Atiya A. McNeal, PharmD, the pharmacy supervisor at Novant’s Forsyth Medical Center, in Winston-Salem, said her team’s approach has resulted in fewer instances of running out of medications and has reduced the system’s reliance on outside compounding and the use of secondary drug wholesalers.

Dr. McNeal outlined how her system works. “There’s a facility-based weekly meeting to assess upcoming shortages, to implement clinical and operational changes, and to develop a back-up plan in case we can’t get a drug and need to think of an alternative,” she noted. This is followed by a weekly corporate conference call with the procurement teams of each facility to coordinate stock. Finally, a weekly communication is sent with shortage information to staff. “It’s time-intensive,” she conceded. “We spend an average of eight hours a week dealing with drug shortages.” All shortage information is maintained in a medication database. “We take counts of our meds every week. For example, there are 187 items currently on our shortage list, ranging from cyclomydrila eye drops to potassium phosphate injections.”

“We decided to do the study after we ran out of meds a couple of times,” Dr. McNeal said. “Once when our suppliers couldn’t get tablets of 7.5-mg warfarin, we split 5-mg tablets in half. We had to change the order profile on each patient taking that drug. Of course, it happened at night when we were short staffed.”

Dr. McNeal was shocked at the high number of medications affected by shortages: “I thought there might be 50 or so. But I was also pleasantly surprised by how well our plan worked to help alleviate problems.”

The initiative “significantly decreased incidences of drugs being completely unavailable,” although hard data on that outcome were not tracked during the study, Dr. McNeal said, explaining that “this was an observational study rather than a quantitative analysis.”

Additionally, she said the health system has been weaning itself off outsourcing these short-supply medications, but again, that outcome “was more of an observation” than a quantified study endpoint. That weaning effort, Dr. McNeal added, “started two years ago and we’re still doing it.”

A final outcome had to do with staff attitudes toward drug shortages. Once the initiative was in place, Dr. McNeal noted, “there were much less people moaning and groaning that we’re out of something. This led to better staff engagement, better teamwork and improved monitoring of medication stocks.”

Dr. Fox said the Novant Health experience illustrates how a large system can make just a few improvements to its shortage management strategy and realize a significant difference. “It could nudge folks concerned about how much effort it takes, because it shows how you’re reaping the benefits in the end,” she said. “It proves the more proactive you are, the better you’ll manage a shortage.”

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