The problem of medication shortages is world wide and calls for a global coordinated effort in order to drive stability in the supply chain. Care providers ‘in the mean time’ have no choice but to make the situation work every day. The general public often doesn’t have an appreciation of the stress this puts on the healthcare system, the care givers and the patient. And our care professionals do their best every day to make the problem least apparent.
Katie Bui, PharmD, provides insights in not only the risk and impact on her pediatric patients, but her article also shines a light on the professionals (pharmacists, nurses, physician) that are dealing with these situations and are often forced to venture into the unknown, with the many insecurities this provides. It will take tremendous efforts at many levels to stabilize the global supply chain.
At MUUTAA we aim to exploit all available medication data for prediction of the best outcome of potential substitutes for a particular patient, and offer this output as a cognitive assistance to the care-giving community.
From Dr. Bui’s article on the Pharmacy Times’ website:
Effect on Day-to-Day Operations
“As a clinical pharmacist specializing in pediatric emergency medicine, I am affected by drug shortages on a daily basis. Besides managing my regular duties of attending codes, educating the health care team and patients, optimizing medication regimens, providing therapeutic recommendations, and working with a multidisciplinary team in the emergency department (ED), I also have to respond to drug shortages, which have become the norm of hospital pharmacy operations. Because this task involves discussion with multiple key drivers, including management, nurses, patients and their family members, pharmacy buyers, and prescribers, the process is cumbersome and time-consuming, diverting valuable attention and time from meaningful patient care activities.
Furthermore, dealing with a drug shortage may delay treatment and increase medication errors, because the staff is unfamiliar with alternative products that have different concentrations, labeling, and packaging. Medication errors can happen in the process of prescribing, verification, compounding, dispensing, and administration. Uncertainty about and unfamiliarity with new products may affect medication safety and, ultimately, patient care. In the worst-case scenario, these alternatives may be less effective or more costly; lead to disease progression, relapse, or treatment failure; or produce more toxic adverse drug reactions.
Mazer-Amirshahi et al looked at the effect of these drug shortages specifically in the ED setting.11 The article noted common ED classes of medications in critical shortage, such as analgesics, antiemetics, antimicrobials, benzodiazepines, and electrolyte solutions. Two examples that may pose a threat to public health are influenza and oseltamivir shortages. The authors discussed several cases of compounding errors and compromised sterility, as well as increased costs and resource use.
Pediatric patients are particularly vulnerable. For example, the zinc shortage resulted in more dermatitis cases at Children’s National Hospital, and the shortage of cefotaxime to treat neonatal fever/sepsis led to greater use of aminoglycosides, which carry the risks of nephrotoxicity and ototoxicity, as well as additional laboratory draws and increased cost, labor, and pain to monitor the drug’s pharmacokinetics.12 Moreover, because of the lack of available dosage forms, pediatric patients need individualized dosing that requires calculations and extemporaneous compounding. The drug shortage crisis poses an even higher risk of medication errors and adverse events for these patients because there are more challenges with delivery systems and administration.”