Pharmacy Steps Up to Handle Drug Shortages, But at What Costs?

A White House official urged pharmacists to communicate publicly how much drug shortages cost their facilities and impact their patients to accelerate efforts to address the root causes of a problem that has vexed health systems for decades.

“A lot of effort has been put into this, but we haven’t done a whole lot to solve the problem,” Chan Harjivan, a pharmacist and a special assistant to the president for biological threats, told attendees at a Wednesday session of the 2024 Midyear Clinical Meeting & Exhibition. “The amount of effort pharmacy puts into mitigating drug shortages is vast. … Pharmacy can do a better job (of saying) ‘Here’s the financial impact, here’s the clinical impact.’”

Harjivan was a speaker at the session Executive View: Leaders Discuss Drug Shortage Policy and IV Fluid Updates.

Other speakers included Erin Fox, associate chief pharmacy officer, shared services, at University of Utah Health; Megan Corrigan, director of pharmacy and emergency management for Advocate Health — Advocate Good Samaritan Hospital; Matthew Grissinger, director of education at the Institute for Safe Medication Practices (ISMP); and ASHP’s Michael Ganio, senior director of pharmacy practice and quality, and Tom Kraus, vice president of government relations.

Before Harjivan spoke, Fox and Corrigan detailed how their institutions are continuing to handle the latest IV fluid shortage, caused by hurricane damage to a Baxter manufacturing facility in North Carolina.

Fox discussed the difficulties of managing fluids, which come in very high volumes, making them difficult to stockpile. She shared a staff chart that maps the IV fluid supplies each day with a color chart showing the severity of the daily impact on patients. She also discussed the importance of using purchasing history to manage irrigation fluids, which can vary widely from physician to physician and are not charted.

Fox pointed out how much time healthcare workers must invest now in managing such a complicated shortage. “Grinding all of your work to a halt to make this happen and reduce your use by 50 to 60%? Can we do that? Absolutely. … Because we’re pharmacists and we can make things happen. But you’ve got to think about the opportunity costs. What have you not been doing because you’re so focused on this new problem?”

Advocate Health gets 90% of its fluid products from Baxter, putting the health system in a tough spot, said Corrigan. She outlined the pharmacy department’s efforts to manage the shortage, including setting up hospital command structures, working closely with nursing, and building a new data tool and shared staff documents to track use.

“Data is key,” she said. “People won’t believe you until they see the numbers.”

In some ways, she said, the data showed that physicians could safely reduce their fluid use for certain procedures. Her staff connected physicians who tended to use a high volume of fluids with colleagues who used much less for the same procedures.

“We got a lot of pushback [from staff] saying, ‘I can’t practice without X amount of fluid.’ Well, you can, and we can prove it,” said Corrigan. “Yes, we have to practice differently, but that doesn’t mean we’re practicing poorly. If we don’t change what we’re doing, we’re going to be out of fluid and then we’re going to have to cancel surgeries.”

ISMP’s Grissinger gave examples of errors that can occur when hospitals deal with fluid shortages, particularly when they use authorized imported products that may have foreign-language labels, lack bar codes, or don’t fit standard tubing. ISMP developed a safety checklist.

“It’s a tool for you to use where you can evaluate the imported products’ safety,” he said.

Ganio shared data from ASHP’s ongoing survey of members about how the shortages are affecting operations. The latest figures show a slowly improving situation, with fewer members reporting the shortages are having critical impacts on patients.

“All the mitigation techniques implemented at the hospital level to conserve supply, but also all the efforts by Baxter and the federal government to respond to the shortage, have moved the needle quite substantially where most are managing the situation without a really critical impact on patient care,” said Ganio.

On the advocacy front, Kraus discussed ASHP’s recommendations to address the drug shortages and noted that he sees an increasing awareness on Capitol Hill.

“There is a small number of members in Congress who are focused on drug shortages, and they increasingly recognize the challenges,” said Kraus.

Harjivan also gave a brief overview of a White House project to address the nation’s reliance on single-source suppliers and a handful of countries to produce lifesaving medication. The U.S. and international partners, including Japan, the European Union, and Korea, are focusing on the supply chain of five medications in order to figure out how to diversify not only the manufacturing of the finished product but also the sourcing for materials along the way.

He emphasized that the issue is one of national security. “If we’re dependent on China, and they cut off supply, that would be crippling to health systems in the U.S. and around the world,” said Harjivan. He said he believes the effort will not falter at the end of the year.

“We think it will continue with the next administration as well, because this is a bipartisan issue,” he said.