Kyle Hoelting, PharmD, BCPS,
Vizient Senior Clinical Manager of Drug Information
In recent years, drug shortages and the management of drug shortages have become a major focus of pharmacy staff within hospitals and health systems. According to the American Society of Health-System Pharmacists (ASHP), a record five-year high of 295 active drug shortages was reported at the end of 2022. With that number unfortunately on the rise – and a new ten-year record high of 301 active shortages during the first quarter in 2023 and 309 active shortages as of the second quarter – it’s especially important for pharmacists and health systems to have an individualized method for keeping track of these shortages.
An institution-specific drug shortage list allows for timely identification of a shortage, assessment of the severity of the shortage and provides data from which appropriate clinical and operational recommendations for mitigation can be made by multidisciplinary representatives.
Pre-existing drug shortage lists
To understand the utility of an institution-specific drug shortage list, it’s important to first note the available national drug shortage lists and the differences of each.
The Food and Drug Administration (FDA) maintains a national drug shortage list, which is inclusive of shortages when manufacturers are unable to meet market demand. The list does not consider a product on shortage if there are one or more manufacturers able to fully support the demand.
ASHP also maintains a national drug shortage list, curated by the University of Utah Drug Information Service. Their list is inclusive of supply issues that affects how the pharmacy prepares or dispenses a drug product or influences patient care when prescribers must use an alternative agent. Simply put, the list details which manufacturers have the medication available, and which do not.
The lists provided by FDA and ASHP are excellent resources to understand shortages on a national level; however, the information can be delayed, overwhelming in quantity or difficult to track on a week-to-week basis. An institution-specific drug shortage list allows hospitals or health systems to focus on the shortages acutely affecting their institution and can be utilized and maintained in concert with the available FDA and ASHP national drug shortage lists or one of the many available drug shortage applications or software programs.
Adding your own list to the mix
A well-maintained institution-specific drug shortage list provides up-to-date information about which shortages are impactful to an institution, the current inventory, average utilization and service line use, and serves as the document from which all pertinent drug shortage decisions for the institution originate.
That’s why the health system’s pharmacy buyer is the perfect person to create and maintain a list like this. Pharmacy buyers are responsible for monitoring the institution’s available inventory of medications and restocking them when inventory becomes low. Throughout their daily responsibilities, pharmacy buyers note which medications are on backorder or currently unavailable and communicate with pharmaceutical manufacturers and wholesalers to determine estimated release dates of medications. The pharmacy buyer then relays this information to multidisciplinary representatives who manage shortages within the institution. With the multitude of shortages and their ever-changing nature, an institution-specific drug shortage list is the foundation and source of truth for all things shortage-related.
The Shortages Subcommittee of the larger Vizient Pharmacy Technician Buyer Committee has developed a template for an institution-specific drug shortage list and recommends the following components:
- Medication: Name as well as formulation, concentration and/or size information, if preferred.
- Status: Shortage status can be categorized by days-on-hand of inventory in conjunction with other metrics:
- Critical: Classified as ≤ 14 days-on-hand and/or no appropriate alternative(s) identified.
- Caution: Classified as > 14 days-on-hand and/or an appropriate alternative(s) identified.
- Monitor: Classified as a national shortage reported by ASHP and/or FDA with stable institution-specific supply.
- Resolved: One of stable supply and is noted as “resolved” by the ASHP drug shortage list due to its broader definition of medications on shortage.
- Quantity-on-hand: Determined by current inventory.
- Days-on-hand: Determined by utilization metrics and current inventory.
- Estimated release date: Provided by manufacturer or wholesaler.
- Alternatives: Potential clinical alternatives approved by subject matter experts.
- Operational changes: Compounding specifics or changes to inventory practices.
- Electronic health record alerts: To notify staff of the shortage and/or recommend alternatives.
- Restrictions: Any restriction criteria for use.
- Supplier and buyer comments: Make note of backorder status, availability directly from manufacturer and allocation specifics.
Best practices for maintaining the list include:
- Adding medications unable to purchase via wholesaler or secondary distributor.
- Adding medications of national interest as identified by ASHP or FDA.
- Updating information at least weekly.
- Reporting out to multidisciplinary shortage representatives based on predetermined institutional cadence.
- Storing list electronically in a location accessible to all hospital staff.
An institution-specific drug shortage list allows health systems to gain a deeper understanding of how these new and ongoing shortages are directly impacting their clinical operations. Storing the list electronically for all hospital staff to access provides staff pertinent information to care for patients, reduces the stress of an unknown shortage and allows other service lines to act as shortage representatives for the pharmacy department. None of this is possible without the pharmacy buyer, or buyers, and their source of truth.
About the author
Kyle Hoelting, PharmD, BCPS is a Senior Clinical Manager, Drug Information for Vizient Pharmacy Solutions. In this role he helps to develop evidence-based medicine deliverables, clinical newsletters, and drug shortage mitigation strategies for the pharmacy membership. Kyle earned his Doctor of Pharmacy degree from the University of Nebraska Medical Center. In addition, he completed both PGY1 Pharmacy Practice and PGY2 Drug Information pharmacy residencies at the University of Kansas Health System. Prior to joining Vizient he was the Clinical Pharmacy Specialist, Drug Information and Drug Policy at Virginia Commonwealth University Health. In his previous role, he was responsible for formulary management, drug policy development, evaluation and management of drug shortages, precepting of pharmacy students and residents, as well as facilitating the drug information call center.