When a drug is in short supply at Beth Israel Deaconess Medical Center in Boston, a message goes out to the physicians on the hospital’s intranet system. When the shortage gets close to being critically short in supply, a message will be embedded into the physician order-entry system recommending that the physicians use an alternate drug—if there is an alternate.
It’s an alert system that has been put to frequent use lately, says Joseph Li, MD, SFHM, director of the hospital medicine program at Beth Israel Deaconess, associate professor of medicine at Harvard Medical School, and president of SHM.
The rate of drug shortages has been rising steadily in recent years due to quality questions at manufacturers, consolidation in the drug-manufacturing industry, and other factors, according to data from the U.S. Food and Drug Administration and other sources.
“It does seem like there’s more today than previous years,” says Dr. Li, who was a pharmacist before he trained in internal medicine.
Some of the recent shortages at Beth Israel Deaconess have involved the diuretic furosemide, the antiemetic Compazine, and the anticoagulant heparin. “More often than not, there’s a reasonable alternative that can be chosen,” he says. “Not necessarily exactly the same drug, but usually in the same therapeutic class.”
While actual cases of patient harm due to drug shortages appear to be relatively uncommon, having drugs in short supply can lead to a safety problem hovering over a medical center and its hospitalists. In addition to the potential of simply not having an alternate to give to a patient, hospitalists and their pharmacists sometimes have to adjust to a new dosage that comes with a replacement medication.
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Plus, having to manage the problem when a drug shortage hits can be a headache, with time and resources spent trying to obtain updates from drug manufacturers and find other drugs that can be used in the meantime, experts say.
With hospitalists now treating so many patients, many of them complex and on multiple medications, it is an important issue for hospitalists to stay aware of and to be prepared for, Dr. Li says. More than 90% of all medical patients at Beth Israel Deaconess are now cared for by hospitalists, he says, and it’s a similar situation for many acute-care hospitals around the country.
If a drug is in short supply, balancing availability with patient needs can be especially tricky for a hospitalist caring for patients with a multitude of demands, Dr. Li says. “There is an effort to make sure that our most vulnerable population of patients receive these treatments before the general population of patients have access to it,” he adds.
However, the very existence of hospitalists makes it easier to navigate a shortage compared to the days when hundreds of providers would be caring for a pool of patients.
“If you’re trying to notify a group of providers about shortages and have an impact on their prescribing habits, I think it’s easier today,” he says.
Troubled Waters
The FDA says it confirmed a record 178 cases of drug shortages in 2010 (www.fda.gov/drugs/drugsafety/drugshortages/default.htm). That was up from 55 shortages five years ago. And according to the University of Utah Drug Information Service, the problem is actually more pervasive than that, reporting 120 shortages in the U.S. in 2001, with a reported 211 in 2010. And through March of this year, there were 80 reported cases of shortages, on pace for another record year.