Pharmacists and Pharmacy Technicians Need Tricks and Tools to Manage Ongoing Drug Shortages

Introduction

Every area of medical practice continues to deal with drug shortages—supply issues that affect how the pharmacy prepares or dispenses a drug product or influence patient care when prescribers must use an alternative.¹ The American Society of Health-System Pharmacists quarterly report listed 244 shortages at the end of July 2024.² Under shortages, health care providers have rationed, delayed, or canceled treatment or procedures.³ Drug shortages can also lead to medication errors or disease progression.^4-6

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Table 1^1,7-10 lists reasons drug shortages occur. Traditionally, generic injectables have been affected most critically, but other drugs can be affected.

Clinical Conundrums

Clinical challenges resulting from shortages (eg, treatment delays, medication rationing, and limited treatment options) tend to be the most problematic for pharmacy staff, although economic and humanistic outcomes are also troublesome.¹¹ Evaluating the medication’s key characteristics is necessary in conjunction with assessing the patient’s situation. For example, Table 2 compares a hypothetical vaccine shortage and an antineoplastic shortage.

Almost all oncology practitioners (93%) have reported drug shortages and subsequently delayed chemotherapy administration or changed a patient’s treatment regimen. A full 85% have reported increased costs or reimbursement challenges.^12,13 These shortages have persisted for more than a decade, with BCG, intravenous (IV) immunoglobin, leucovorin, vinblastine, and vincristine—all older agents—in shortage most often.^12,13

Picking Up the Pieces

Pharmacists and pharmacy technicians must act based on their scope of practice when shortages arise. If staffing shortages are a concern, the workload can be a problem^.2,14 Pharmacy technicians can augment the pharmacist’s clinical work and perform many administrative tasks. Table 3 lists online resources that all pharmacy employees can access. Keeping that list handy will save time when a shortage is developing.

Different drug products require different approaches. For example, in 2017, the US experienced nationwide shortages of IV bags after Hurricane Maria devastated Puerto Rico. Some neurocritical care units switched to IV push routes when possible and used formulary substitutions or alternative therapies in some cases. Clinical pharmacists reserved their small supply of IV bags and released them only for patients with critical needs.¹⁵ Optimizing the use of multidose vials is another approach that can reduce medication waste and cost; this may require training for staff and monitoring for adherence to best practices.¹⁶

Larger pharmacies or institutions must implement systemic measures. Some actions require pharmacy leadership, but a multidisciplinary team needs to develop clinical strategies.¹⁴ Table 4^2,7,14,17,18 describes the typical tasks needed to address shortages.

Conclusion

Drug shortages wax and wane but seem to be here to stay. Pharmacy staff can use proven tactics to manage current drug shortages. Having plans or algorithms to follow and using them consistently can increase the odds of finding a viable replacement and reduce stress.

REFERENCES

1. Fox ER, Sweet BV, Jensen V. Drug shortages: a complex health care crisis. Mayo Clin Proc. 2014;89(3):361-373. doi:10.1016/j.mayocp.2013.11.014

2. Drug shortages statistics. American Society of Health-System Pharmacists. Accessed August 1, 2024. https://www.ashp.org/drug-shortages/shortage-resources/drug-shortages-statistics

3. Severity and impact of current drug shortages. American Society of Health-System Pharmacists. June/July 2023. Accessed August 2, 2024. https://www.ashp.org/-/media/assets/drug-shortages/docs/ASHP-2023-Drug-Shortages-Survey-Report.pdf

4. Schmidt B. ISMP: short of everything except errors: harm associated with drug shortages. Patient Safety and Quality Healthcare. June 4, 2012. Accessed August 1, 2024. https://www.psqh.com/analysis/ismp-short-of-everything-except-errors-harm-associated-with-drug-shortages/

5. Bourneau-Martin D, Babin M, Grandvuillemin A, et al; French Network of Regional Pharmacovigilance Centres. Adverse drug reaction related to drug shortage: a retrospective study on the French National Pharmacovigilance Database. Br J Clin Pharmacol. 2023;89(3):1080-1088. doi:10.1111/bcp.15550

6. Drug, supply, and equipment shortages continue to compromise patient care. Institute for Safe Medication Practices. September 7, 2023. Accessed August 1, 2024. https://www.ismp.org/resources/drug-supply-and-equipment-shortages-continue-compromise-patient-care.

7. Aronson JK, Heneghan C, Ferner RE. Drug shortages. Part 1: definitions and harms. Br J Clin Pharmacol. 2023;89(10):2950-2956. doi:10.1111/bcp.15842

8. Aronson JK, Heneghan C, Ferner RE. Drug shortages. Part 2: trends, causes and solutions. Br J Clin Pharmacol. 2023;89(10):2957-2963. doi:10.1111/bcp.15853

9. Sule S, DaCosta MC, DeCou E, Gilson C, Wallace K, Goff SL. Communication of COVID-19 misinformation on social media by physicians in the US. JAMA Netw Open. 2023;6(8):e2328928. doi:10.1001/jamanetworkopen.2023.28928

10. Han SH, Safeek R, Ockerman K, et al. Public interest in the off-label use of glucagon-like peptide 1 agonists (Ozempic) for cosmetic weight loss: a Google trends analysis. Aesthet Surg J. 2023;44(1):60-67. doi:10.1093/asj/sjad211

11. Phuong JM, Penm J, Chaar B, Oldfield LD, Moles R. The impacts of medication shortages on patient outcomes: a scoping review. PLoS One. 2019;14(5):e0215837. doi:10.1371/journal.pone.0215837

12. McBride A, Holle LM, Westendorf C, et al. National survey on the effect of oncology drug shortages on cancer care. Am J Health Syst Pharm. 2013;70(7):609-617. doi:10.2146/ajhp120563