Ongoing drug shortages have forced many healthcare systems to develop strategies to continuously adapt to ever-changing supplies of medications, including antibiotics, sedatives, vasoactive agents, and many other medications used across the full spectrum of critical care medicine. As has been previously described, the development and use of various multidisciplinary approaches has been successful in reducing the perceived negative impact on patient outcomes related to shortages.(1) Most commonly, these approaches utilize drug shortage teams or committees to review the specific details of current and future shortages, to assess the likelihood of substantive supply disruption and potential solutions within their own healthcare system, and to apply an individualized approach that includes the development of therapeutic interchanges, shortage medication restrictions, and acquisitions from alternative distributors.
Despite the success of these approaches, they are all labor intensive and utilize a significant amount of clinician-related resources. Information technology (IT) offers the potential to create automated systems for evaluating and responding to drug shortages today and in the future. In this article, we attempt to highlight ways that healthcare systems have successfully leveraged their IT systems in the era of drug shortages.
One interesting way that IT can be leveraged to reduce the impact of drug shortages is to implement IT solutions that affect the initial order entry in an era of increasing adoption of electronic medical records (EMRs) and computerized provider order entry (CPOE). Because CPOE enables providers to directly enter medication orders into an EMR, CPOE is primarily utilized to improve efficiency in medication prescribing, delivery and prevention of medication-related errors. In the setting of drug shortages, CPOE can also be used to direct providers to alternate therapies.
At Saint Luke’s Health System in Kansas City, Missouri, the CPOE system has been successfully utilized to communicate medication shortages to providers and to recommend appropriate therapeutic alternatives for affected drugs. For some shortages, the response needed was quite simple and required minimal additional IT support, such as the creation of an automated alert within the CPOE system that recommended therapeutic alternatives or restrictions that were previously approved by the Pharmacy and Therapeutics Committee. Occasionally, as in the case of a recent ketorolac shortage, a more complex and resource-intensive strategy was employed. During this shortage, all of the post-operative order sets at Saint Luke’s Health System were revised to limit ketorolac use to only the first 24 hours after surgery. By modifying the orderable medications in the health system’s central medication list, many affected order sets were updated in a timely manner. In addition, the healthcare system implemented clinical monitoring and reporting tools that helped pharmacists to easily identify those patients that needed to be converted to an alternative therapy.
IT can also be leveraged to improve communication about drug shortages and to inform clinicians not only about the best alternative agents to use, but also the underlying causes and likely duration of these shortages. For example, Thomas Jefferson University Hospital (TJUH) in Philadelphia, Pennsylvania, recently experienced a significant shortage of one of its primary empiric antibiotics, piperacillin/tazobactam. At the start of the shortage, the institutional drug shortage committee quickly developed an action plan with an appropriate therapeutic interchange, vetted this change through the Pharmacy and Therapeutics Committee, and then developed a plan for hospital-wide communication related to this shortage.
This communication plan was electronically distributed and consisted of a three-pronged approach. First, an electronic notification was placed on the TJUH CPOE message board. This message board is visible to all providers upon log-in. Second, a brief memo was emailed from the chair of the Pharmacy and Therapeutics Committee to all clinical providers; this included physicians, mid-level providers, pharmacists and pharmacy staff, bedside nurses, and respiratory therapists. Finally, the drug shortages link on the clinician page of the hospital intranet was updated. The Drug Shortage Committee also developed a process to routinely monitor the American Society of Health-System Pharmacists (ASHP) Drug Shortages website (http://www.ashp.org/menu/DrugShortages/CurrentShortages
) as an effective way to proactively monitor ongoing and newly reported shortages.
In addition to the strategies described above, the University of Kentucky Chandler Medical Center (UKCMC) also leverages IT by reducing the impact of frequent meetings on the clinical and transportation costs to the enterprise. The UKCMC Drug Shortage Task Force frequently employs IT to schedule and host online discussions about ongoing shortages within the healthcare system.
While the task force has a physical location within the Department of Clinical Pharmacy offices, an increasing amount of the task force’s work is done in virtual environments. These include teleconferences, video conferences and even web-based conferences to allow task force members to provide input and feedback while maintaining their presence in their clinical or administrative environments, including locations both in and out of the main hospital complex. In addition, when specific guidance related to a drug shortage is needed from other clinicians, it is now possible to bring them to the discussion without requiring those specialists to walk down or drive over to the physical meeting space. These virtual meetings allow clinicians to stay connected with the drug shortages task force while remaining within the hospital patient care areas or outpatient clinics.
Information technologies can be leveraged in several different ways to mitigate the negative clinical impact of drug shortages while potentially reducing the direct costs to individual institutions. As one example of this type of solution, Saint Luke’s Health System utilized their CPOE systems to automatically restrict drug usage in a recent ketorolac shortage. As another example, TJUH facilitated communication about drug shortages through IT resources, including widely-disseminated emails, targeted CPOE message boards, and updated online resources for providers seeking additional information. Finally, the UKCMC improved their ability to connect clinical and administrative leaders to their institutional drug shortage task force through the use of IT-related conferencing solutions. Taken together, these three healthcare systems demonstrate some of the most common ways that IT can be leveraged today to reduce the negative impact of ongoing and varied drug shortages.
1. Chan-Tompkins NH, Curinga R, Fera T. Surviving drug shortages: a perspective from the hospital pharmacy. P&T. 2002; 27:117-9.