Use resources wisely when stocking drugs
Better care can be a result
The question of what drugs to stock is a complicated one that your facility’s medical staff and pharmacy committee will address, but risk managers have a role to play in the process, too, especially if you suspect a problem.
The problem could simply be that those in charge of stocking the formulary do not realize the risk management implications of insufficient drug supplies. Cost control often is in competition with the ideal practice of medicine, but the risk manager may be able to deliver a message that, surprisingly, supports spending a few more dollars. Go ahead and buy the drugs, the risk manager might say, so the doctors can practice good medicine and the hospital is exposed to less liability.
That may not always be the message, but the risk manager should let the other parties know what the risk management implications are, says Charles Self, JD, director of risk management and insurance at the University of Alabama at Birmingham Medical Center. Smaller hospitals, in particular, will have to make careful choices about how to spend pharmacy funds, notes Denny Thomas, director of risk management at St. Joseph’s Hospital in Marshfield, WI.
"I did some checking after I saw the antidote research, but I found that we have everything we need," Thomas says. "That’s because we’re a 500-bed, tertiary care facility, but I know that wouldn’t be the case at a lot of smaller facilities."
Self and Thomas offer these suggestions for making sure your facility has the most appropriate stock of drugs possible:
• Discuss recent antidote research with the appropriate hospital leaders.
The risk manager could send a copy of the Colorado research to the pharmacy director, for example, with a note asking whether there is any reason for concern. Volunteer that you see some risk management implications in the antidote stocking, as well as with other drugs, and offer to discuss the issue.
• Assess potential cases in your area.
If financial restrictions prevent a facility from stocking every drug that might one day be needed, play the odds. Know the national figures for how often certain medications are needed, and factor in local conditions that might make a difference. Snakebites are far more common in some parts of the country than in others, for example. Local industries also might make some poisonings more common. A predominance of elderly residents could increase the need for digoxin antidote.
• Make sure doctors are adequately well-about antidote availability and similar issues.
Thomas notes that front-line physicians must be familiar with what is immediately available to them so that they know how to respond in an emergency. Physician orientation also should include education about local industries that might expose workers to poisons and toxins.
"That is an important concern, especially with locum tenens and other staff that might not be from this area," he says.
• Consider alternatives to purchasing.
Buying a drug and having it on the shelf for years may not be the only solution. With some drugs, it may be sufficient to have a backup system in place so that the drug can be obtained from another local facility, a regional teaching facility, or the manufacturer on short notice. That will not be possible if the drug is needed within minutes, but for others, a delay of an hour or a day might not threaten the patient.
Whatever the backup policy, it should be formal and carefully considered. If you will depend on another hospital to provide the medication, make sure you formalize that agreement.
"There may be cases where it is cheaper to hire a helicopter and airlift a vial of medicine than to keep it on stock," Self suggests.
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