Survey: Drug Shortages Affect Patient Care, Add to Costs

A survey of pharmacy directors finds that they blame drug shortages for causing medication errors and adding to institutional costs.

A recent survey of clinical pharmacy directors indicates that drug shortages, which have been particularly widespread in recent years, lead to medication errors, adverse events, patient complaints, and increased institutional costs.

Alternate therapies are often used to replace drugs that are in shortage, but previous research has shown that patient care may still be affected, causing medication errors and adverse reactions. The current study, published in the November/December 2013 issue of the Journal of Managed Care Pharmacy, surveyed pharmacy directors to evaluate the effects of drug shortages on patient outcomes, clinical pharmacy operations, patient complaints, and cost to health care institutions.

Pharmacy director members of the MedAssets Pharmacy Group Purchasing Organization were invited to participate in the online survey via email. The survey was conducted from October 2 to 23, 2012, and consisted of multiple choice questions on the effects of drug shortages observed during the 2 years prior to the survey. Of 1516 directors of pharmacy in the MedAssets membership database who were contacted, 193 took part in the survey. Most respondents were from acute care institutions serving fewer than 100 patients. The drugs they most commonly reported to be in shortage were analgesics and anesthetics, antiemetics, and electrolytes/total parenteral nutrition.

The results of the survey indicate that drug shortages negatively affect patient care. Of 174 survey respondents who indicated whether possible or probable adverse events related to drug shortages had occurred, 41.4% reported that 1 to 5 such events had occurred, while 42% reported none had occurred. Of 183 respondents who indicated whether medication errors associated with drug shortages had occurred, 53% reported that 1 to 10 had occurred, and 2.2% reported that more than 30 had occurred. Omission, dispensing or administering the wrong dose, and dispensing or administering the wrong drug were the most common errors reported.

Respondents also indicated that drug shortages resulted in delayed care, cancellation of care, and use of alternative medications. Of 134 respondents who reported a delayed care event related to drug shortages, 56.5% said 1 to 5 delays occurred, 22.1% noted 6 to 10 delays, and 21.4% reported more than 10 delays. Of the 60 respondents who said that care had been cancelled as a result of drug shortages, 88.3% cited 1 to 10 cases of cancelled procedures, surgeries, chemotherapy, and other treatments. Almost 4 in 10 respondents reported fielding at least 1 patient complaint related to shortages.

Institutional costs also appeared to be increased by drug shortages. Among respondents who estimated quarterly institutional costs from drug shortages, 73% reported costs greater than $100,000 and more than a third of respondents said that at least a half an extra full-time equivalent employee was required to help manage shortages. Almost 75% of comments from survey participants mentioned increased institutional costs associated with drug shortages.

The authors of the study suggest that future research should focus on identifying strategies to reduce medication errors, adverse events, and other consequences that may occur during drug shortages.