Collaborative Management Strategies for Drug Shortages in Neurocritical Care

• Type of Material: Article
• Authors: Sarah L. Clark, Mayo Clinic; Kimberly Levasseur-Franklin, Tufts Medical Center; Mehrnaz Pajoumand, University of Maryland Medical Center; Megan Barra, Massachusetts General Hospital; Michael Armahizer, University of Maryland Medical Center; Deepa Patel, Emory University; Katleen Wyatt Chester, Emory University; Andrea P. Tully, Christiana Care Health System
• Language: English
• Date: 2020-02-01
• Publisher: Springer
• Publication Version: Final Published Version
• Copyright Statement: © 2019, Springer Science+Business Media, LLC, part of Springer Nature and Neurocritical Care Society.
• Final Published Version (URL): http://dx.doi.org/10.1007/s12028-019-00730-7
• Title of Journal or Parent Work: Neurocritical Care
• Volume: 32
• Issue: 1
• Start Page: 226
• End Page: 237
• Grant/Funding Information: There was no funding granted/needed for this manuscript by or from any of the authors.
• Keywords: Natural disasters; Drug shortages; Patient care; Neurocritical care; Medication errors
• Research Categories: Health Sciences, Public Health

Abstract

Drug shortages have become all too familiar in the health care environment, with over 200 drugs currently on shortage. In the wake of Hurricane Maria in September 2017, hospitals across the USA had to quickly and creatively adjust medication preparation and administration techniques in light of decreased availability of intravenous (IV) bags used for compounding a vast amount of medications. Amino acid preparations, essential for compounding parenteral nutrition, were also directly impacted by the hurricane. Upon realization of the impending drug shortages, hospitals resorted to alternative methods of drug administration, such as IV push routes, formulary substitutions, or alternative drug therapies in hopes of preserving the small supply of IV bags available and prioritizing them for them most critical needs. In some cases, alternative drug therapies were required, which increased the risk of medication errors due to the use of less-familiar treatment options. Clinical pharmacists rounding with medical teams provided essential, patient-specific drug regimen alternatives to help preserve a dwindling supply while ensuring use in the most critical cases. Drug shortages also frequently occur in the setting of manufacturing delays or discontinuation and drug recalls, with potential to negatively impact patient care. The seriousness of the drug shortage crisis reached public attention by December 2017, when political and pharmacy organizations called for response to the national drug shortage crisis. In this article, we review institutional mitigation strategies in response to drug shortages and discuss downstream effects of these shortages, focusing on medications commonly prescribed in neurocritical care patients.