Manage drug shortages proactively to limit risks
ISMP has issued guidelines based on survey input
A recent study conducted by the Institute for Safe Medicine Practices (ISMP) in Huntingdon Valley, PA, found that only 5% of its 344 pharmacist respondents had established a formal process for managing drug shortages. That didn’t stop the respondents from offering advice on how to handle the problem. Here are some recommendations ISMP gleaned from respondents’ advice and management plans:
• Keep abreast about drug shortages. Assign a staff member to regularly search the literature and web sites (such as the Food and Drug Administration’s [FDA]) for information.
• Attempt to obtain needed supplies. Call the manufacturer to get information, a release date, and directions for ordering drugs on allocation or for emergency supplies. Determine if the current inventory will be sufficient. If not, try to obtain an alternative from another supplier/ wholesaler or order allocated or emergency supplies directly from the manufacturer. Establish a tickler system to check stock and reorder at the appropriate levels.
• Perform a literature search and conduct a drug use evaluation (DUE). Identify clinically appropriate uses of the drug, the lowest optimal dose for current indications, strategies to decrease drug waste, alternative products, and priority uses for extreme shortages. Perform a DUE to determine how the drug actually is being used in your facility.
• Place limitations on use. Based on the extent of the shortage, availability of alternatives, and results of a DUE, develop plans to restrict use and reduce waste.
• Remove supplies from floor stock when possible and have pharmacy dispense the drug.
• Select an alternative product. Obtain suggestions from the literature, web sites, physicians who use the product, and other local hospitals. Select alternatives early so an education plan can be developed in case implementation is needed.
• Alert departments to the shortage, possible substitutes, and potential adverse events. Alerts can be sent through e-mail, pharmacy newsletter, biweekly memos, posters/charts in units, or through information system messages that appear automatically upon initial log-in.
• Institute strategies to avoid errors with substitutes. Precautions include staff education, use of auxiliary labels, automatic computer alerts, and anesthesia consultation if used outside the operating room.
• Proactively monitor adverse events. Monitoring can occur through usual error reporting systems or through additional methods such as a hot line, chart review, focus group meetings, or discussions during pharmacy rounds.
• Monitor and report drug shortages. Report any drug shortages to the FDA (www.fda.gov/cder/drug/shortages) and to the American Society of Health-System Pharmacists’ Drug Shortage Management Resource Center (www.ashp.org/shortage).
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