What is the safest and most sustainable approach to mitigating drug shortages at a health system, Pharmacy and Therapeutics (P&T) committee?

Safest and Most Sustainable Approach to Mitigating Drug Shortages in Health Systems

Working with the P&T committee to establish policies for therapeutic interchange is the safest and most sustainable approach to mitigating drug shortages at your health system. 1

Understanding Drug Shortages in Healthcare Systems

Drug shortages have reached record levels in recent years, affecting numerous medications and creating significant challenges for healthcare systems 2. These shortages arise from multiple factors including:

• Supply chain disruptions
• Manufacturing quality issues
• Outdated production facilities
• Purchasing policies prioritizing lowest price over reliability
• Market concentration issues
• Geopolitical constraints

Why Therapeutic Interchange Policies Are the Best Approach

Benefits of P&T Committee Involvement

• Systematic Approach: The P&T committee serves as the primary formal communication link between pharmacy and medical staff, making it ideally positioned to address medication shortages 3
• Evidence-Based Decisions: P&T committees can evaluate therapeutic alternatives based on safety and efficacy data 4
• Standardized Protocols: Establishing policies ensures consistent approaches across the health system, reducing variability and potential errors 1
• Multidisciplinary Input: P&T committees include physicians, pharmacists, and other healthcare professionals, providing diverse expertise for complex decisions 5

Implementation Strategy

1. Develop a Formulary Management System:

   • Specify drugs of choice and alternatives based on safety and efficacy
   • Minimize therapeutic redundancies
   • Maximize cost-effectiveness 3

2. Create Shortage Response Protocols:

   • Establish criteria for therapeutic substitutions
   • Define approval processes for alternatives
   • Develop communication pathways to inform clinicians of changes

3. Leverage Pharmacist Expertise:

   • Utilize pharmacists to canvass procurement options
   • Consolidate inventory effectively
   • Prepare medications to prevent need for some clinical interventions 6

Why Other Approaches Are Less Effective

Purchasing 3-Month Supply of Medications

• Short-term solution: Only addresses immediate needs without sustainable framework
• Storage challenges: May create inventory management issues and potential waste
• Cost implications: Ties up financial resources that could be used elsewhere
• Hoarding effect: Could worsen shortages for other facilities if widely adopted

Having Patients Bring Their Own Medications

• Safety concerns: Introduces risks of medication errors, improper storage, and counterfeit products
• Equity issues: Creates disparities based on patients' ability to obtain medications
• Regulatory challenges: May violate institutional policies and accreditation standards
• Liability concerns: Increases institutional risk when administering medications not procured through approved channels

Diverting Patients to Other Facilities

• Disruption of care: Compromises continuity of care and patient-physician relationships
• Patient burden: Creates additional stress and hardship for patients
• Reputation damage: May negatively impact the health system's standing in the community
• Ethical concerns: Potentially abandons responsibility for comprehensive patient care

Best Practices for P&T Committee Therapeutic Interchange Policies

1. Establish Clear Criteria:

   • Define clinical equivalence standards
   • Identify high-risk medications requiring special consideration
   • Create protocols for special populations (pediatric, geriatric, critical care)

2. Develop Communication Strategies:

   • Create standardized alerts for clinicians about shortages
   • Provide education on alternative therapies
   • Establish feedback mechanisms to monitor outcomes

3. Implement Verification Processes:

   • Apply the five-rights rule before administration
   • Use two-person verification for high-risk medications
   • Ensure proper labeling of all medications 1

4. Monitor Outcomes:

   • Track adverse events related to therapeutic substitutions
   • Assess clinical efficacy of alternative therapies
   • Evaluate cost implications of interchange policies

By working with the P&T committee to establish policies for therapeutic interchange, health systems can create sustainable, evidence-based approaches to managing drug shortages while maintaining high standards of patient care and medication safety.