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Drug shortages impact hospitals, pharmacies, patients and the economy

Not conforming to typical laws of supply and demand, drugs shortages can be chronic, lasting years, and compensating behaviors hospitals are forced to take can endanger patients and drive up costs.

HDA
HDA

While new drug shortages may have been on the decline (at least until last year) since the FDA Safety and Innovation Act of 2012 (FDASIA), overall shortages are still increasing with some drugs in chronic short supply.

These remarks came from Michael Ganio, Director, Pharmacy Practice and Quality for American Society of Hospital Pharmacists, at Healthcare Distributors Alliance 2019 Distribution Management Conference and Expo help in Palm Desert, CA, March 10-13.

FDASIA requires drug manufacturers to notify the FDA about permanent discontinuance or temporary interruption of production. And allows the FDA to take measures to prevent shortages such as asking other manufacturers to pick up the slack, expedite reviews or inspections for those suppliers wanting to fill the gap, and even allow manufacturers to import to meet shortages. The FDA has also extended expiry rates when possible to keep drugs in the pipeline.

Shortages may be due to a variety of issues, including regulatory delay, discontinuation, manufacturing quality issues, raw material shortages of both active and inactive ingredients, increased demand, and natural disasters.

Recent critical shortages include: small volume parenteral saline solutions, injectable opioids, sterile water for injections, local anesthetics, electrolytes, cardiac emergency drugs, and generic chemotherapy agents.

ASHP conducted a survey of hospitals to determine the effects of the small volume parenteral saline solution shortage. While large “hanging bags” of saline are used to hydrate, the small volume bags are used to deliver medications intravenously. Initially after only a few weeks of SVP shortage, 61% of hospitals reported the shortage having severe impact, affecting daily operations and patient care. And 78% reported having less than a 14-day supply on hand. As the shortage continued, in a subsequent follow up survey, 75.6% of hospitals said the impact of the shortage was severe.

How did hospitals cope with the shortage?

79.6% IV push (nurse stands at beside for 20 minutes pushing the meds directly into patient)

70.6% centralized hospital inventory for greater control

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