ALEX KACIK June 26, 2019 04:18 PM
Drug shortages cost providers nearly $360
million a year in labor expenses, a new survey has found.
Hospitals and affiliated facilities dedicate
more than 8.6 million hours per year working around persistent drug shortages,
according to a new Vizient survey of 365 health system employees polled from July
to December 2018. The distraction resulted in at least one medication error for
38% of the organizations surveyed by the group purchasing and consulting
organization.
"For a drug that is in shortage today and
you are able to find a replacement, tomorrow there may be no alternative
available or a different drug is short," said Dan Kistner, senior vice
president of pharmacy solutions for Vizient. "Then you have to cancel
infusions or procedures and prioritize the patients that need it the most.
There is not one fix for all drugs, that is why providers spend so many hours
to do all they can to limit exposure and risk."
Hospitals indicated that pharmacy buyers spend an average of 12 hours a week
navigating drug shortages, followed by more than nine hours for pharmacists,
nearly eight for pharmacy technicians, almost four for informatics pharmacists,
and more than one for finance workers, nurses and physicians each. Vizient then
extrapolated the results for all U.S. hospitals and calculated the median wage
of each worker to come up with $359 million.
Ochsner Health System, for instance, has
pharmacy experts across the organization who are constantly calling wholesalers
and suppliers to get a hint of what drug may soon be in short supply. It has a
phone call twice a week with its pharmacy, supply chain, chief nursing and
chief operating officers to identify the next problem, said Dr. Robert Hart,
executive vice president and chief medical officer for Louisiana-based Ochsner.
They determine whether the shortage is related
to a particular drug, supplier or dosage and then find workarounds detailed in
the system's electronic health record.
"We have to always be looking where the
next issue might be," Hart told Modern Healthcare in January.
Every health system surveyed has been impacted
by drug shortages, with nearly two-thirds reporting that they had to juggle at
least 20 shortages. Controlled substances, local anesthetics, antibiotics,
electrolytes and emergency injectables such as "crash cart"
drugs are the most common products in short supply.
In addition to higher labor costs, providers
lost revenue due to delayed or canceled procedures, invested in new technology,
mitigated medication errors, and purchased drugs through different suppliers,
which Vizient did not quantify.
"Years ago, we rarely heard about
this," Hart said. "The frequency has increased."
Sixty-four percent of respondents said they were
dealing with more than 21 drug shortages, 33% were managing six to 20 and 3%
were handling five or fewer. The total number of annual new shortages reached
its highest number since 2012 at 186 in 2018.
The shortages stem from a lack of generic
manufacturers. Suppliers opt for more profitable branded therapies over
generics, so one natural disaster or quality issue throws a wrench in the
entire supply chain. Manufacturers base production on historic supply levels,
which means it's a reactive process when shortages arise.
Providers also claim to have minimal insight
into the causes of shortages. Manufacturers aren't mandated to share with the
public whether contaminated raw ingredients, a production snafu or other
factors led to the shortage, which means stakeholders can't target vulnerable
products and plan ahead, they say. That is a gap the Food and Drug
Administration's Drug Shortage Task Forceaims to fill.
"There is a limited capacity of products
that are being made," Kistner said. "So when someone goes down, it
hurts."
The answer can't just be to pay more—that does
not boost transparency or guarantee supply, he added.
The most effective strategies to mitigate the
impact of drug shortages included implementing processes to restrict therapy
duration, creating a drug shortage committee, raising the threshold for
electrolyte replacement guidelines, purchasing alternative presentations like
syringes or vials, identifying vulnerable products and increasing stock, and
implementing unit dosing to reduce waste.
Vizient has teamed up with provider-backed
generic drug manufacturer Civica Rx to bolster its data analysis.
Premier subsidiary ProvideGx is also working with drugmaker Fresenius
Kabi to mitigate drug shortages of injectable thiamine, lidocaine,
diphenhydramine, hydromorphone and morphine sulfate. It has targeted more than
60 drugs in shortage, starting with sterile injectables.
Pharmaceutical manufacturer B. Braun Medical is also boosting its IV solution
manufacturing capacity.
"We believe rising tides lift all
boats," Kistner said. "Drug shortages are caused by so many different
problems, it's going to take a multitude of solutions. If any new generic
manufacturer comes forward, we want to help them."
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