A hospital patient needs treatment, but the medicine drawer for the drug they need is empty. What happens next?

That’s a scenario too many hospital staff members deal with on any given day. While consequences of dealing with hospital drug shortages include loss of staff productivity and higher cost to the hospital, most distressing are the negative impacts to patient care.

Last summer, The New York Times reported hospital ERs around the country were struggling for months without crucial medications, such as morphine for pain relief and the heart drug diltiazem.

But those weren’t isolated incidents. Hospital pharmacy leaders have struggled with drug shortages for more than a decade, sometimes due to manufacturing problems, procurement issues, and natural disasters. For many years those drug shortages happened under the radar, but more patients today are becoming aware of the direct impact to their care.

Patients experience the pain of drug shortages first-hand

Today more than 200 drugs are in short supply, according to the American Society for Hospital Pharmacists. Current shortages include medicines for relieving pain, treating cancer and heart conditions, and fighting infections.

In most cases, patients won’t know if they aren’t given their doctor’s first-choice medication. Nor are they likely to realize how drug shortages disrupted the hospital’s typical work patterns, requiring staff to scramble and spend significant time coming up with alternative treatments.

But patients experience first-hand when the replacement medication doesn’t resolve their symptoms. They’re also all too aware when faced with real-life scenarios like these:

• A patient suffers adverse effects from a drug given as an alternative to the preferred treatment for his condition.
• A phone call from the hospital tells the patient her scheduled procedure has been delayed, because the medications needed for the surgery aren’t available.
• The preferred and more effective drug isn’t available to treat an ER patient with a racing heart. The replacement drugs his doctors tried didn’t work for him, so he has to be admitted overnight to receive a steady drip of yet another drug alternative.
• Another patient arrives for her chemotherapy treatment only to learn the cancer drug is in short supply, and she needs to switch to a different therapy or delay treatment.

Reports: Drug shortages delay and harm patient care

A survey in May 2018 by the American College of Emergency Physicians found 9 of 10 emergency physicians said they have experienced shortages or absences of critical medicines, and nearly 4 in 10 said drug shortages had negatively impacted patient outcomes, including direct patient harm.

When drug shortages force hospital staff to spend time searching for alternative treatments, this can delay patient procedures and other services. Nearly 90% of responding emergency physicians report having to take time away from patients to explore the viability of alternative treatments and medications.

A report released in January 2019 by the American Hospital A­ssociation (AHA), the Federation of American Hospitals (FAH), and the American Society of Health-System Pharmacists (ASHP) found not only continued rising drug prices, but also shortages for many critical medications, are impacting patient care and putting strains on hospital budgets and operations.

According to that report, almost 80% of hospitals found it extremely challenging to obtain drugs experiencing shortages. FAH president and CEO Chip Kahn says:

“We see a developing crisis. Relentless drug price increases and all too frequent shortages of critical medications are eroding the capacity of hospitals to provide our patients needed care.”

Addressing the issue of drug supply shortages in the January 2019 ASPR blog, the U.S. Department of Health and Human Services – Office of the Assistant Secretary for Preparedness and Response says:

“Supply shortages threaten patient health even in the best circumstances…With so many shortages, one is likely to impact your hospital or healthcare facility at some point. By planning to cope with the impacts of a supply shortage, your hospital or healthcare facility will be better prepared to continue providing patient care when one occurs.”

A 2019 scoping review by the National Center for Biotechnology Information focused on drug shortages and patient outcomes in a range of medical literature. The review found medication shortages have become a growing worldwide issue in recent years, and patients “were more commonly reported to have increased out of pocket costs, rates of drug errors, adverse events, mortality, and complaints during times of shortage.”

Empowering pharmacists to better manage drug shortages

Hospital pharmacies use a well-defined and highly controlled system of processes to get the right drug, in the right form and dose, to the right patient at the right time. Any change in the system, such as suddenly dealing with a specific drug shortage and finding viable alternatives, adds risk to the system and ultimately the patient.

As experienced health system pharmacy professionals, we know how seriously and personally our peers take the care of all of their patients. Weighing on every pharmacy professional we’ve worked with is the worry they might be rushed into a situation where they have to change a drug and/or the processes around that drug, compromising the patient’s care if something gets delayed or overlooked.

That’s why working to empower pharmacists is so important to us, so health system patients can receive the best care. We’re all about giving pharmacists advanced awareness, providing more options to proactively manage data and workflows, and reducing complexity through automation, as explained in our mission:

“Empower pharmacy leaders with the tools they need to proactively mitigate the ongoing impacts of medication shortages, and deliver them with intelligent, intuitive solutions that hospitals can deploy to protect their patients from harm while efficiently responding to supply chain threats.”

To schedule a demo of the OrbitalRX solution, send us a message.

Every minute, in every hospital, patients trust their doctors and nurses to treat them with the drugs they need. Yet many of those patients aren’t aware drug shortages are an under-the-radar crisis that has plagued hospital pharmacy leaders for more than a decade.

Adam Orsborn and Nate Peaty, co-founders of OrbitalRX’s drug shortage management solution, dealt with that crisis first-hand in their prior pharmacy roles at Wake Forest Baptist Health in Winston Salem, North Carolina. There, more than 300 pharmacy employees work around the clock to ensure the medications providers depend on to care for patients are there when they need them and used safely.

“The problem we faced managing drug shortages was having so many different data sources and stakeholders that needed to collaborate,” says Peaty, PharmD and OrbitalRX chief product officer. “There wasn’t anything other than Excel spreadsheets and a bunch of people trying to gather data to tie it all together.”

There had to be a better way.

Underlying causes of drug shortages vary

Drug shortages drew national attention more than a year ago after Hurricane Maria cause major disruption in Puerto Rico’s substantial pharmaceutical manufacturing industry, which serves patients globally.

Other causes of drug shortages include quality issues in manufacturing, a limited number of manufacturers of certain drugs, and unexpected spikes in demand.

Hospital and health system pharmacies have been managing and mitigating the impact of drug shortages for years, relying on manual means, more man-hours, and data systems that fell short of delivering on their promises.

Hospital pharmacy leaders grow frustrated with lagging technology

“We were dissatisfied with the state of technology, even back when we were in pharmacy training at the University of Wisconsin,” says Orsborn, PharmD and OrbitalRX CEO.

They knew healthcare technology had untapped potential for data and analytic capabilities they wanted for their pharmacy systems.

He and eventually Peaty left Wake Forest Baptist Health to consult with other technology companies, offering their real-world hospital pharmacy experience to help technology advance more quickly for their peers in the medical community.

They found hospital pharmacy leaders were thankful to talk with a vendor who understood them and talked their language.

“Hospital pharmacy leaders depend on technology solutions every minute of the day, to take care of hundreds, sometimes thousands of patients in their health system,” says Peaty.

“Because we have first-hand experience of what they’re going through, we know how important it is for them and their team members to have useful and reliable data at their fingertips, wherever they are at the moment, so they can ensure patients have the medications they need.”

A solution built by pharmacy leaders, for pharmacy leaders

Two years ago, Peaty and Orsborn turned their pharmaceutical and consulting expertise into OrbitalRX, a pharmacy automation company to help pharmacy leaders in hospitals more easily and effectively use data to better manage drug shortages.

The two each have a decade of experience in the hospital pharmacy setting, in many instances having done their customers’ job longer than their customers have.

“We can speak to what drives them crazy,” says Peaty, “because we’ve experienced it: inventory data that’s spread across systems, an unmanageable amount of information in multiple drug purchase catalogs, and lack of documentation when trying to communicate effectively with stakeholders. Our technology solution addresses all three of these areas.”

Since hospital pharmacy leaders are often on the move, working in and between meetings, the OrbitalRX drug shortage management solution is designed to be mobile, for real-time information and assessment. The solution also scales for enterprise use, allowing large hospital health systems to better collaborate across multiple sites.

Product demos have garnered feedback from hospital pharmacists who say:

• Drug shortages are the most frustrating thing in my day-to-day work
• Right now we’re really working toward minimizing anything manual
• This looks great; you’re solving a problem no one has figured out yet.

The cost of managing drug shortages

The expense of trying to manage drug shortages manually adds up, both in cost to the hospital as well as negative impact on patients.

“When you’re a hospital pharmacy leader faced with a drug shortage,” says Orsborn, “all of a sudden you have to figure out, where do I keep this drug? How much do I have on hand? Who is using it, and how fast are they using it? What are the alternatives that work the same way in the human body? Where can we buy those alternatives? What’s the best price I can get, and how long is that supply going to last?”

Many hospital personnel have to collaborate to answer those questions, often gathered around a spreadsheet, searching through catalogs, and collecting data from several different systems. One such huddle meeting could equal $1,000 to $1,500 dollars’ worth of labor expense. Multiply that several times a week for various drugs – such as Puerto Rican-produced saline bags.

The University of Virginia Medical Center in Charlottesville has been using the OrbitalRX drug shortage management solution as a single platform from which the team can control all the medical center’s pharmacy systems and collate data feeds from their disparate systems.

The UVA medical center can be proactive and replenish inventory at a lower price point than if they only reacted to shortages. Rafael Saenz, PharmD, the director of pharmacy at the medical center, says he hopes to save more than $200,000 in fiscal year 2019.

Reducing risk in patient care

Hospital pharmacies manage medication use with a well-defined and highly controlled system of processes, which move a drug product from the loading dock all the way to the patient.

“Any change in that system adds risk, especially when that change happens unexpectedly,” says Peaty. “When you’re expecting to have one of the most important medications you rely on day to day, and it’s not there, suddenly your health system is having to make changes to a bunch of different systems and processes around that important drug. They may not have the time to really think through the consequences of a lot of those changes, and that is terrifying to most pharmacists.”

Orsborn and Peaty founded OrbitalRX to give pharmacy professionals more advanced awareness of those types of situations as well as more options to respond to them. Their drug shortage management solution helps reduce complexity, proactively manage data and workflows, and better communicate with hospital leaders and other departments about how to manage drug shortages. Peaty says:

“All of those things have a net value that rolls up and results in safer, better care for patients in our health system.”

To schedule a demo of the OrbitalRX solution, send us a message.

Related:

• FDA Drug Shortages
• McKesson: Best Practices for Hospitals and Health Systems in an Era of Drug Shortages