December 2017
clinical initiatives, research and current updates in treatment
Medication Shortages John Evans, Slade Pharmacy and Erin Musgrave, Icon Group Pharmacy Practice Unit Medication shortages are a substantial problem for hospitals across Australia resulting in significant implications for patient care, staff resourcing and expenditure.1 The causes for shortages are complex and can be multifactorial (Refer Table 1). The Society of Hospital Pharmacists of Australia conducted a survey on the 4 April 2017 to ascertain the extent of drug shortages in Australian hospitals. The key findings were:1 ¬¬ 100% of respondents (n= 280 healthcare providers) had experienced a medicine shortage in the preceding 12 months ¬¬ 95% of respondents recorded at least one medicine shortage on the survey date ¬¬ Across all respondents 365 different commercial products across 154 different active ingredients were recorded as out of stock ¬¬ Entries covered a wide range of medicine classes; the most frequent recorded shortages were antimicrobials (20%), then anaesthetics/analgesia (12%), cardiology (10%), endocrinology (10%), chemotherapy (9.5%) and neurology (9%) ¬¬ There is a lack of accurate timely information provided by sponsors and wholesalers: –– in 70% of cases, medicines were found to be unavailable only after orders were unable to be filled –– Of the 365 different medicine product shortages reported in the survey, only 54 (14.8%) were reported on Therapeutic Goods Administration (TGA) Medicines Shortage Initiative website on the survey date
–– Information provided on the TGA Medicines Shortages Initiative website on 4 April did not align with reported hospital experience indicating the ‘date of supply’ information was largely inaccurate ¬¬ There is a need for proactive notification of medication shortages to reduce burdensome workarounds ¬¬ Recommendation for a legislative change to enforce the requirement for improved notification of medication shortages from manufacturers or wholesalers to the Federal Government
What is being done to manage medication shortages? 1. There are regulatory processes to enable access to substitute medications from overseas or supply of an otherwise unapproved medication therapy. Unfortunately these additional regulatory and logistical requirements often come at a significant cost increase which is passed on by the sponsors 2. The TGA has established the Medicines Shortages Information Initiative. This web site consolidates manufacturers information regarding current drug shortages and their estimated time of return availability. Unfortunately this is a voluntary initiative and the site has proven to be an unreliable and incomplete record, as was reflected in the recent SHPA survey 3. Wholesalers and manufacturers are now starting to control release of batches of affected drugs to ensure an equitable supply to all facilities
What are our pharmacies doing to manage medication shortages? 1. A dedicated procurement team analyse drug usage data to forecast requirements and manage ongoing supplies and advise where stock may require redistribution across the pharmacy network for equitable access 2. Automatic ‘second sourcing’ to find an available alternative brand to the out of stock drug 3. Identifying alternative sources - where there are no available brands with TGA registration, the procurement team works with agencies to identify overseas registered drugs and make them available under Special Access Scheme 4. Regular Communication: –– Drug-specific memos when supply issues are identified –– Stock status update emails 5. Researching and recommending clinical alternatives: –– The Pharmacy Practice Unit, clinical pharmacists (in consultation with specialist medical staff) provide advice regarding potential alternative treatments Given the multifactorial reasons for the medicine shortages there is no one-simple (or quick) fix. We can expect medicines shortages to remain a serious issue for the forseeable future. The key then is how to effectively handle the issue. A systematic approach to drug shortages when sourcing medications, in tandem with timely and effective communication from manufacturer through to clinical staff, is essential to support optimal patient care. Please contact your local pharmacist for further guidence. References are available on request.