Learning from IV Drug Shortages: Be Prepared and Proactive

Drug shortages aren’t going away anytime soon, which is why it’s important for pharmacies to put preparedness plans in place ahead of future IV shortages, according to an interactive discussion held this week at the ASHP Summer Meeting and Exhibition in Denver, CO.

“We need to start thinking of this almost as we do an emergency preparedness process,” Patricia Kienle, BSPharm, MPA, FASHP, Director of Accreditation and Medication Safety at Cardinal Health Innovative Delivery Solutions, explained at the talk, which was sponsored by Baxter.

Kienle, along with Kevin Hansen, PharmD, MS, BCPS, Assistant Director of Pharmacy at Moses H. Cone Memorial Hospital, and Richard Montgomery, BSPharm, MBA, Contracts and Operations Manager at Adventist Health System, convened to discuss best practices in IV preparation and administration post shortages.

Drug shortages can impact methods of compounding sterile products, which can lead to higher risk of medication errors. Establishing preparedness processes, and best practices can help mitigate errors in the event of shortages.

According to an audience poll, 40% of attendees indicated running out of essential components due to shortage, and 35% reported that their supply was low enough to communicate plans for imminent shortage. Additionally, 77% of attendees responded that they were aware of medication errors that occurred at their site based on shortage.

Kienle emphasized the importance of compliance with USP <797> regulations. Education and staff training is key to ensuring that processes are compliant, as well as assessment of resources, facilities, procedures, and work practices. Additionally, use of beyond-use-dates longer than the defaults listed in <797> require testing and monitoring.

“We certainly have a responsibility to the patient we treat to follow those regulations and best practices,” Kienle said.

Attendees also indicated in an audience poll that shortages at their institutions have led to an increase in manual compounding (47%), increased outsourcing (31%), introduction of automation or technology (8%), or an increase in high-risk compounding practices (12%).

Use of manual admixture and IV push can cause medium to high risk of potential patient harm in the event of drug shortages. However, dispensing premixed, ready-to-use formulations has significantly less medication error rates.

“Anytime a premixed drug product is available, that’s what I’ll be dispensing to my patients,” Hansen said. When using adult IV push medications, Hansen noted that ISMP recommends ready-to-administer forms in order to minimize manipulation outside of pharmacy sterile compounding area.

According to Hansen, pharmacists can use safe practice guidelines to perform alternative compounding or administration techniques.

For pharmacy staff, drug shortage crises provide an opportunity to be proactive, determine which practice changes need to be made, and set an action plan to be prepared for the next shortage that occurs. “Drug shortages are going to become a part of standard pharmacy operations,” Hansen stated.