Impact of drug shortages on U.S. health systems

Kaakeh, Rola; Sweet, Burgunda V.; Reilly, Cynthia; Bush, Colleen; DeLoach, Sherry; Higgins, Barb; Clark, Angela; Stevenson, James G.

doi:10.2146/ajhp110210

Cited by 182 publications

(190 citation statements)

References 8 publications

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“…Since respondents to our survey remain anonymous, we have no means to 31 The human costs identified in this survey included frustration and worry about delivering anesthetics under what was perceived to be suboptimal conditions. The monetary costs of drug shortages are not well recognized.…”

Section: Discussionmentioning

confidence: 99%

Drug shortages in Canadian anesthesia: a national survey

Hall

Bryson

Flowerdew

et al. 2013

Can J Anesth/J Can Anesth

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Background Canadian physicians are faced with an increasing frequency of drug shortages. We hypothesized that drug shortages have a clinical impact on anesthesia care in Canada. Methods We conducted a self-administered survey of anesthesiologists in Canada using the membership list of the Canadian Anesthesiologists' Society. For survey development, we identified key domains, including types of drug shortages, impact on the ability of anesthesia practitioners to provide general anesthesia care, and impact on patient outcomes. We undertook assessments of face validity, clinical sensibility, and content validity. Respondents were surveyed from January-April 2012. Results Completed valid questionnaires were submitted by 1,187 respondents (61.4%), and 779 (65.7%) of respondents described a shortage of one or more anesthesia or critical care drugs. Changes in anesthesia practice resulting from drug shortages were common; 586 (49%) respondents thought they had given an inferior anesthetic, and 361 (30%) reported administering medications with which they were unfamiliar. Respondents also reported that drug shortages were, at times, responsible for changes in the conduct of patient care, with 28 (2.4%) noting cancellation or postponement of surgery and 92 (7.8%) witnessing a drug error. One hundred sixty-five (13.9%) respondents regarded drug shortages as having prolonged recovery from anesthesia, and 124 (10.5%) viewed drug shortages as resulting in an increased number of postoperative complications, such as postoperative nausea and vomiting. Interpretation Drug shortages are common in anesthetic practice in Canada. This state of affairs may have a negative effect on how anesthesiologists practice anesthesia and may be associated with adverse patient outcomes. 123Can J Anesth/J Can Anesth (2013) 60:539-551 DOI 10.1007/s12630-013-9920-z Résumé Contexte Les me´decins canadiens font de plus en plus souvent face a`des pe´nuries de me´dicaments. Nous avons e´mis l'hypothe`se que les pe´nuries de me´dicaments avaient un impact sur les soins en anesthe´sie au Canada. Méthode Nous avons re´alise´un sondage auto-administreá upre`s des anesthe´siologistes au Canada en nous fondant sur la liste des membres de la Socie´te´canadienne des anesthe´siologistes. Lors de la mise au point du sondage, nous avons de´termine´des domaines cle´s, notamment les types de pe´nuries de me´dicaments, l'impact sur la capacite´des fournisseurs d'anesthe´sie a`offrir des soins d'anesthe´sie ge´ne´rale, et l'impact sur les devenirs des patients. Nous avons e´value´la validite´apparente, la sensibilite´clinique, et la validited u contenu. Les re´pondants ont reçu le sondage entre janvier et avril 2012. Résultats Au total, 1187 (61,4 %) re´pondants ont comple´ted es questionnaires de façon valable, et 779 (65,7 %) de ces re´pondants ont de´crit une pe´nurie d'un me´dicament ou plus utilise´en anesthe´sie ou en soins critiques. Les changements dans la pratique de l'anesthe´sie dus a`des pe´nuries de me´dicaments e´taient courants; 586 (49 %) re´...

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Section: Discussionmentioning

confidence: 99%

Drug shortages in Canadian anesthesia: a national survey

Hall

Bryson

Flowerdew

et al. 2013

Can J Anesth/J Can Anesth

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“…Results of the current survey corroborate those of past assessments, demonstrating how shortages have impacted hospital pharmacies and the delivery of optimal patient care. 9,23 When a health care institution is faced with a drug shortage, it must follow a systematic process to address the shortage. Contacting the manufacturer for direct orders and centralizing stock, which according to our survey takes at least an additional 0.5 to 1 FTE, are useful tactics that can bridge the gap until supplies are available from regular channels.…”

Section: Discussionmentioning

confidence: 99%

Impact of Drug Shortages on Health System Pharmacies in the Southeastern United States

et al. 2015

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Background:Drug shortages have become all too common and affect all aspects of the health care delivery system. The increased number of drug shortages has had a negative impact on patient care as well as costly financial implications. Objectives: This article identifies the current problems and negative outcomes drug shortages have caused and provides a framework for how to best prepare for and combat future shortages. It highlights specific problems faced by health care system pharmacies in the Southeastern United States and the managerial responses to address these shortage situations. Methods: A 34-question, multiple-choice survey was distributed to pharmacy directors in North Carolina, South Carolina, Georgia, and Florida. Results: Of 549 surveys distributed, 219 (40%) responses were received. Respondents reported that drug shortages cause 1% to 5% error rates in hospitals and that 60% of the time drug shortages create unsafe conditions for patients and staff. Many of the respondents reported a 300% to 500% markup on medications on the shortage list. Seventy-six percent of institutions have autosubstitutions for drug shortages that have been preapproved by Pharmacy & Therapeutics Committees. Conclusions: The causes of drug shortages are multifaceted, and the safety and financial implications can be costly. In the short term, health care institutions can utilize pharmacists to assist in circumventing the drug shortage problem. The combined efforts of all health care professionals, the US government, manufacturers, and the lay public are necessary to bring awareness and plausible solutions to the drug shortage problems in the long term. Impact of Drug Shortages cardiovascular agents are common. [3][4][5][6] The primary causes for these shortages include inadequate raw materials, decreased number of manufacturers, and other factors that cause production to stall or be terminated. 7,8 Delayed or lack of communication among the FDA, manufacturers, and health care providers may contribute to the inadequate preparation in managing drug shortages. 1 The impact of drug shortages is multifaceted, with over 50% of health care practitioners believing that shortages have influenced practice and resulted in inferior patient care. 9 A Canadian study from Hall et al relayed anesthesiologists' opinions that drug shortages were responsible for prolonged recovery times, delayed surgical procedure scheduling, and increased recovery cost. Nearly half of them (49%) felt shortages were the impetus for the administration of inferior anesthetics. 6 Drug shortages often impact vulnerable populations including cancer patients or neonates, for whom few, if any, equivalent alternatives exist; shortages may result in clinical complications, as exemplified by selenium shortages. 10-13 Drug shortages may also force practitioners to prescribe infrequently used medications and concentrations, which can lead to medication errors as demonstrated with prior fentanyl shortages. 6 Drug shortages have also impacted life outside of patient...

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“…1 Previous surveys suggest that institutions across the United States are experiencing patient harms that are attributable to drug shortages. [1][2][3][4] In 1 survey, almost two thirds of pharmacy director respondents believed that drug shortages have changed patient care. 3 These patient harms included medication errors or near misses, adverse events, cancelled care, and delayed care.…”

Section: What This Study Addsmentioning

confidence: 99%

Effects on Patient Care Caused by Drug Shortages: A Survey

McLaughlin¹,

Kotis²,

Thomson³

et al. 2013

JMCP

106

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BACKGROUND: Drug shortages pose a serious challenge for health care institutions, often interfering with patient care. A common practice during a drug shortage is to select an alternate therapeutic; however, these agents often present challenges and may create safety concerns. Patient harms including adverse events and medication errors may occur. Patients may also file complaints because of drug shortages. OBJECTIVE: To measure the effect of drug shortages on patient outcomes, clinical pharmacy operations, patient complaints, and institutional cost.METHODS: An e-mail link to an online survey was sent to pharmacy director members in the MedAssets Pharmacy Group Purchasing Organization. Data were collected within a 3-week period from October 2-23, 2012. The survey focused on 6 different domains: demographics, adverse events, medication errors, patient outcomes, patient complaints, and institutional cost. RESULTS:The survey was sent to 1,516 directors of pharmacy. There were 193 respondents (response rate 13%) who participated in the survey. Approximately 40% of respondents reported between 1 and 5 adverse events probably or possibly associated with drug shortages at their institution. The majority of respondents reported between 1 and 10 medication errors. The most common types of medication errors reported were omission (n = 86, 55.5%), wrong dose dispensed/administered (n = 85, 54.8%), and wrong drug dispensed/administered (n = 54, 34.8%). The most common outcomes reported by respondents were alternative medication used (n=146, 85.3%), delay of therapy (n = 121, 70.8%), and increased patient monitoring necessary (n = 84, 49.1%). Patient complaints were reported by 38% of respondents. The majority of respondents reported an estimated quarterly institutional cost from shortages of less than $100,000, and approximately one quarter of respondents reported adding at least 1 full-time equivalent to manage drug shortages. The majority of participant comments mentioned the increasing institutional costs attributed to drug shortages.CONCLUSIONS: Medication errors and adverse events continue to occur from drug shortages, often resulting in inadequate patient care, high institutional costs, and patient complaints. Delayed care and cancelled care have been reported from shortages. Further research is necessary to better classify medication errors and adverse events during a drug shortage.

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Impact of drug shortages on U.S. health systems

Abstract: A survey of directors of pharmacy revealed that labor costs and the time required to manage drug shortages are significant and that current information available to manage drug shortages is considered suboptimal.

Cited by 182 publications

References 8 publications

Drug shortages in Canadian anesthesia: a national survey

Drug shortages in Canadian anesthesia: a national survey

Impact of Drug Shortages on Health System Pharmacies in the Southeastern United States

Effects on Patient Care Caused by Drug Shortages: A Survey

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