A proactive approach to drug shortages: 6 strategies from Advocate Health Care's director of central service pharmacy

Hospitals rarely, if ever, receive advanced notice of drug shortages, which can make preparing for low inventory levels difficult.

To ensure future shortages don't hurt patient care, hospitals must implement protocols to routinely monitor purchase orders, look for signs of imminent shortages and respond accordingly, says Trac Pham, RPh, director of central service pharmacy for Downers Grove, Ill.-based Advocate Health Care.

Mr. Pham, who oversees the procurement, preparation and delivery of medications across Advocate's 12 hospitals, says drug shortages are a constant challenge for the health system.

Advocate stocks about six to eight different Hospira products in its crash carts, emergency rooms and operating room suites that are currently experiencing shortages. Pfizer acquired Hospira in 2015 and has since faced a slew of manufacturing and production issues, contributing to a nationwide shortage of critical injectable drugs.

"That's probably our biggest issue right now," he says. "There's also a slew of other medications — including chronic meds, oncology meds and injectable meds — that have been on and off of continuous backorder."

At present, drug shortages are not affecting patient care at Advocate, in part due to the health system's thorough processes for predicting and responding to low inventory levels.   

Here are six tactics Mr. Pham uses to address drug shortages at Advocate.

1. Staff the right personnel on the front lines. Advocate relies on inventory control specialists, who work on the frontlines and submit purchase orders on a daily basis, to look for specific purchasing trends and identify potential drug shortages.

"These folks have the critical thinking skills to identify red flags — such as backorders, partial fulfillments or orders from another distribution center across the country — that indicate we may have an issue," Mr. Pham says.

Empowering frontline employees to identify these red flags helps Advocate take a proactive approach to mitigating shortages before they arrive.

2. Assess inventory. Once an inventory control specialist identifies a potential issue with a drug, the hospital should assess its current inventory, according to Mr. Pham.

He believes supply chain and pharmacy leaders should ask themselves the following questions: How much is sitting on the shelf today? What's the hospital's utilization or burn rate? How long is the current supply going to last in terms of number of days on hand?

"For most hospitals, their inventory is not perpetually or electronically visible," he says. "This inventory assessment is not always the easiest thing to do, but it's one of the early critical steps many hospitals fail to take into account."

3. Collaborate with multiple stakeholders. Supply chain and pharmacy leaders must work with medical staff to evaluate potential shortages and implement proactive measures, according to Mr. Pham. Identifying alternative therapies, prioritizing patients who should receive the affected drug on low inventory and modifying clinical plans going forward are all essential preparations that require input from numerous stakeholders across the hospital or health system.

"There's a supply chain component, an operational component and a clinical component that must be addressed during shortages," he says. "It really takes a collaborative approach with all players involved, including medical staff."

4. Develop a timely communication strategy. Mr. Pham says developing an effective communication flow between executives and employees is also critical to navigating drug shortages

"If a patient doesn't get a drug they need, a physician will march up to the C-suite and have a discussion with them," he says. "So looping in executive leadership to have that critical conversation with medical staff is important."

5. Keep the health information management system up-to-date. Updating the HIM system in pace with drug shortages can be difficult. However, the practice is important to ensure uninterrupted patient care. "When a physician signs into a computer, alternative drugs must be in place and visible to the clinician as he's ordering medications for patients," Mr. Pham says.

6. Harness the power of predictive analytics. Advocate is working with Omnicell, a Mountain View, Calif.-based automation and business analytics software company, to develop a predictive modeling tool for drug shortages. The tool, still in an early development phase, will conduct a regression analysis of medications in Advocate's system and identify market variables that have historically driven shortages. Mr. Pham hopes the tool will help Advocate take a more proactive, rather than reactionary, approach to drug shortages.

"If we can fine tune this tool to point us in the right direction, we can at least have some sense of what could be coming on the market as a shortage," he says. "Drug shortages are here, and they're not going away. It's really about trying to stay ahead of the curve, understanding the cause of the shortage and mitigating that as much as possible."

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