Drug shortages are nothing new to pharmacists, but the coronavirus pandemic intensified the problem as overwhelmed hospitals ran short on drugs needed to treat COVID-19 patients. Hospital pharmacy leaders across the country have struggled to keep a steady supply of drugs needed to put patients on ventilators, such as sedatives and pain meds.
As states begin to reopen and the U.S. faces the possibility of a second wave of COVID-19, health system leaders will have to prepare for the possibility of continued drug shortages. During a May 21 virtual panel hosted by Becker's Hospital Review and sponsored by Omnicell, pharmacy leaders from four health systems shared the lessons they've learned about dealing with drug shortages amid a pandemic.
The pharmacy leaders were:
- Indu Lew, PharmD, senior vice president and chief pharmacy officer at RWJBarnabas Health in West Orange, N.J.
- Kevin Roche, PhD, senior director of pharmacy prep and dispensing at Banner Health in Phoenix
- Anthony Scott, PharmD, assistant director of pharmacy operations at the University of Chicago Medicine
- Lisa Polinsky, RPh, assistant vice president of pharmacy services at LifeBridge Health in Baltimore
Here are some key takeaways from the event:
- The drugs pharmacy leaders have most struggled to obtain are drugs needed to put patients on ventilators, such as sedatives and painkillers, as well as drugs being studied to treat COVID-19, such as remdesivir and hydroxychloroquine. The types and severity of drug shortages have shifted as new information became available on how COVID-19 patients respond to different therapies.
"As soon as something new would come up about a new drug that was potentially something to treat COVID-19, you'd go to your wholesaler and it was immediately gone," Ms. Polinsky said. - Pharmacy leaders are increasingly concerned about their supply of analgesics and anesthetics as hospitals begin to increase the number of elective surgeries they perform.
"You probably can't run your operations if you can't provide analgesics to patients, especially in injectable form," Dr. Scott said.
Dr. Roche said he's concerned that as Banner Health ramps up elective procedures, propofol, an anesthetic, could go into shortage. - One of the biggest challenges hospital pharmacies have faced is having to utilize a number of drugs that they haven't used before and aren't included in their health system's EHR.
Dr. Scott said his team prioritized medication safety and made sure they had the appropriate systems in place to monitor the alternative drugs. His team also worked closely with the clinical team to keep them informed of the new medications they would be using. They also worked with the informatics team to make sure the new drugs were included in the hospital's EHR. - Strategies to mitigate shortages include switching to in-house compounding for certain drugs, switching from IV to oral drugs where possible and using a centralized warehouse approach for distribution.
Dr. Scott said that at the University of Chicago, his team has not had to compound any drugs that are commercially available, but they shifted some drugs they were unable to get from their 503B vendors to in-house compounding.
At LifeBridge Health in Baltimore, Ms. Polinsky said her team has switched patients to oral drugs where possible so they didn't have to waste IV drugs, which are harder to obtain.
Dr. Lew said that at RWJBarnabas Health, the team designated one person to keep track of medication inventory coming in, another to know the utilization of the medications and a third to give instruction on where to dispatch the medications. - Communication across the entire health system was key to getting through the peak of the crisis, the pharmacy leaders agreed. They stressed that supporting their teams, whether through childcare services, food services or mental health resources was a primary focus.
"We know we can't operate our department properly without supporting our employees," Dr. Scott said.
Ms. Polinsky said the leadership team in her pharmacy department made sure that they were visible to staff and stayed in the hospital instead of working from home to make sure they were available to support the front-line workers.
"You balance social distancing with keeping employees mentall healthy so they felt that we were here and we were available to them," Ms. Polinsky said. - Expand medication intelligence for improved decision-making. With the anticipated, continued demand for medications to treat COVID-19 (not to mention new medication demands as medical and surgical procedures ramp back up), health systems will need to pay close attention to their medication inventory.
Many hospitals experienced drug shortages and supply chain disruptions during the first wave of COVID-19 surges.
"To avoid these issues during a second wave, pharmacists must have clearer visibility into inventory. This will give them the ability to proactively identify inventory challenges and plan accordingly," said Jim Stevenson, vice president of Medication Systems Strategy at Omnicell, who moderated the event.
To view the full virtual panel, click here.