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22
Specialty Pharmacy Continuum • January/February 2022
POLICY
Conserve supplies, prioritize needs, NHIA advises
Taming Ambulatory Infusion Pump Shortage By Dave Doolittle
As a nationwide shortage of ambulatory infusion pump administration sets continues, pharmacists should take steps to conserve supplies while prioritizing patients with specific delivery needs, according to the National Home Infusion Association (NHIA). The shortage “is specific to the administration sets commonly used by home infusion providers to administer continuous infusions to patients on therapies such as parenteral nutrition,” NHIA president and CEO Connie Sullivan, BSPharm, told Specialty Pharmacy Continuum. “NHIA was first made aware of the challenges by members in early December 2021.” The NHIA issued a guidance (bit.ly/ 3G1bBa4) that recommends ways pharmacists can navigate the shortage, such as rationing supplies and considering nonpump options for administering medications. It also advises against stockpiling inventory “in the interest of fair allocation to all patients nationally.” According to the guidance, pharmacists should consider: • assessing or reassessing each patient for the indication and requirement for an ambulatory infusion pump; • reserving pumps for situations in which flow accuracy is critical to patient response and safety; and • using non-pump options for administering antibiotics, hydration, monoclonal antibodies and more. Several non-pump options are recommended in the guidelines, including using gravity administration and flow regulators for medications not at risk for free-flow complications; converting all nurse-administered therapies to gravity infusions; and prioritizing elastomeric infusion and syringes whenever possible. “As a last resort, consider extending the time between bag and/or set changes,” the guidance says. Pharmacists also should work with patients and physicians to determine whether it is possible to prescribe equally effective medications that do not require ambulatory infusion pumps, the guidance notes. The NHIA also recommends pharmacists take time to understand each patient’s learning needs and home situation to create an effective learning plan if changing medication administration, including assessing fall risk if using pole-mounted pumps. Smiths Medical, the Minneapolisbased specialty medical device manufacturer that supplies the majority of sets, said it is once again producing at full capacity—“with normal levels of supply
arriving at our distribution center in mid-January.” However, the shortage is still ongoing, caused by backorders and “unprecedented demand which is likely a market reaction to inventory concerns associated with global supply chain challenges,” the company said in a Dec. 21, 2021, letter (bit.ly/3H8k10R). The continuing shortage has begun to negatively affect pharmacy businesses as well as patient care, Ms. Sullivan said. Some companies have had to spend extra capital to buy new pumps, while others are not accepting new patients whose therapies require such pump sets.
Steering Clear of Shortages However, some companies have been able to navigate the shortage, such as New York–based Upstate HomeInfusion. CEO Greg LoPresti said the firm began taking steps early to avoid delivery interruptions, based on watching other supplychain issues throughout the COVID-19 pandemic. “The old standard is changing. Before it used to be ‘just in time,’ now it’s ‘expanding your inventory,’” Mr. LoPresti said. “Nobody wanted to have dead-head inventory on your shelves, but you have to now, or else it’s going to impact future revenue, because you will not be able to meet sales demand, and more importantly, serve your patients.” In addition, Upstate HomeInfusion has taken several steps to conserve infusion pump sets for critical-access patients, including those needing pain control and total parenteral nutrition when precise flows are needed. The company also has been using rate-flow sets to deliver antibiotics, hydration or monoclonal antibodies that require their own tubing set, he said. “You have to have multiple different delivery channels—and this is mainly done by our pharmacy—for delivering medication just as the NHIA guidance states, and that’s exactly what we’ve done,” Mr. LoPresti said. “It’s a multipronged operational effort that requires your purchasing department, pharmacy and nurses all to be in lockstep. It’s not something you can do in hindsight.” The sources reported no relevant financial disclosures.
