How hospitals navigate medication shortages

A nurse taking out medications from a refrigerator in a medical center

In recent years, we’ve seen periodic drug shortages because of sudden increase in demand, limited supply of raw materials, natural disasters or other problems that affect production facilities, as well as challenges with labor and logistics. Other factors that can contribute to medication shortages include regulatory compliance, quality control of the manufacturing process, and market forces, such as medication profitability and company mergers and acquisitions.

Most recently, we’re seeing a shortage of the antibiotic amoxicillin — specifically the oral formulation prescribed often for children.

All of these forces combine to increase the pressures on health care providers like The Ohio State University Wexner Medical Center as we seek to provide high-quality patient care despite challenges with medication access.

To that end, at Ohio State we’ve assembled a multidisciplinary team of physicians, nurse practitioners, pharmacists, pharmacy technicians, nurses, dietitians, supply chain experts and IT staff that are dedicated to the ongoing monitoring of medications that are on shortage. Our goal is to maintain the provision of safe and effective care while minimizing the impact to the end user — prescribers, nurses and patients.

Over the years, the team has successfully implemented a number of best practices and strategies to prevent the rare scenario that we would completely run out of a particular product. These strategies include but aren’t limited to:

Operational changes within the Department of Pharmacy

For example, to navigate an IV fluid shortage, our pharmacy technicians can draw fluid out of more readily available large-volume bags to make the smaller bags that are in short supply. As you can imagine, this effort can put a significant strain on an already strained labor force.

Change the medication administration method

For some medications, frontline nurses can administer via IV push instead of IV infusion, which decreases the overall use of small volume IV bags. This method involves putting the medication in a syringe and pushing the medication into the bloodstream over a specified amount of time — typically 3 to 5 minutes. This change requires additional nursing time, since the nurse has to remain at the bedside while the medication is being administered.

Prescriber alerts

We’ve implemented numerous alternative alerts in the electronic health record to help redirect and educate prescribers on alternative therapies when a particular medication is in short supply. Hard stops and soft stops are included in the alerts and could require that a prescriber contact a pharmacist to place an order for a medication in critical shortage — a hard stop. Soft stops are warnings that educate the provider that a medication is in short supply and provides alternatives both in terms of medications and their dosing.

Daily monitoring

The Ohio State Department of Pharmacy tracks 275 to 300 products at any given time. For those medications that require changes in our clinical and/or operational practice, they’re placed in an electronic Drug Shortage Database. The database is meant to provide real-time information on the current operational or clinical changes necessary to manage the shortage. This information can change rapidly, so it’s an effective tool to educate our staff on changes in a timely and accurate manner.

Over the years, we’ve become incredibly proactive and nimble when it comes to decision making about alternative medications to maintain an adequate supply for our patient population. Our ability to maintain supply is a result of the partnership that exists across our multidisciplinary team and a willingness of our prescribers and pharmacists to carefully consider and evaluate appropriateness and alternatives during critical shortages.

Long-term planning

Medication shortages are going to affect us for a long time. The Ohio State Wexner Medical Center invests a significant amount of time and resources in managing medication shortages, and that allows us to preserve a supply of medications for our patients who need it most.

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