Contemporary Perspective on Supply Chain Management Regarding Drug Sourcing Shortages

Safeguarding the supply of drugs and satisfying the needs of patients is a strategic priority of any healthcare system especially in these pandemic times. The pharmaceutical supply chain is subject to many pressures including non-availability and shortage of requisite drugs. A drug shortage is a deficiency in the supply of medicines or products that affects the ability of a patient to get the required treatment in due time. The roots of drug shortages are multifaceted, varied, and the issue can be due to supply or demand. However, the situation affects almost every stakeholder in the healthcare system, which is why collaboration is a must to deal with drug shortages. Hence, adopting an exploratory and single-case approach of the largest public hospital in the context of Namibia, the objective of this chapter is to provide a contemporary perspective of supply chain management re drug sourcing shortages, analyze the causes of drug shortages, recommend measures to minimize the crisis, and suggest strategies for enhanced efficiency in drug supply.

Household Drug Stockpiling and Panic Buying of Drugs During the COVID-19 Pandemic: A Study From Jordan

The coronavirus disease that emerged in 2019 (COVID-19) has affected health, societies and economies. Policies that have been imposed by different countries to slow the spread of the disease, including national lockdowns, curfews, border closures and enforcement of social distancing measures have disturbed the drug supply chain and resulted in drug shortages. Uncertainty concerning the pandemic has also led to the panic buying of drugs and the stockpiling of drugs in households, which has amplified the problem. In this cross-sectional study, a self-developed questionnaire was distributed online in order to a) assess the practice of household drug stockpiling prior to the national lockdown in Jordan, b) investigate the factors affecting it and c) measure peoples’ knowledge about the consequences of this behaviour. Results from this study show that drug purchasing was reported by 44.3% of the participants and was most common among participants from non-medical backgrounds (336, 75.7%) or those who have chronic diseases (261, 58.8%) and taking chronic supplements (282, 63.5%) regardless of their age, gender, living area or the possession of health insurance. Analgesics and antipyretics were the most frequently purchased drugs (225, 70.5%) and anticipation of their need was the most common reason for purchasing drugs (231, 52.0%). Buyers were also less aware, when compared to non-buyers, that panic buying and drug stockpiling may lead to drug shortages (204, 45.9% vs 325, 58.1%) and that this behaviour can pose a health hazard, especially to children (221, 47.5% vs 342, 61.2%). Our study shows that panic buying of drugs and household drug stockpiling were common in Jordan during the COVID-19 pandemic and this was related to participants’ medical knowledge and educational backgrounds. Therefore, educating the general population regarding rational drug use is urgently needed. This is also a compelling case for the development of national guidelines for drug management that target the general population and healthcare personnel, especially pharmacists, to avoid drug shortages during crises.

Perceptions of pharmacists towards drug shortages in the healthcare system of Pakistan and its impact on patient care: findings from a cross-sectional survey

ObjectiveThis study aimed to explore pharmacists’ perceptions on drug shortages and its impingement on the Pakistani healthcare system, in particular on patient care.DesignOnline questionnaire survey.Setting and participantsHospital pharmacists from five out of seven regions of Pakistan were approached; including the federal territory (Islamabad) and four provinces (Khyber Pakhtunkhwa, Balochistan, Punjab and Sindh).Primary and secondary outcome measuresPrevalence and type of shortages were identified along with strategies to reduce its effect on patient care.MethodA validated questionnaire was distributed through various online platforms to 800 registered hospital pharmacists. A convenience sampling technique was used to obtain information on drug shortages, the reporting system for shortages, the impact on patients and policy solutions for managing drug shortages.ResultsOut of 800 hospital pharmacists, 708 completed the questionnaire (response rate: 88.5%). Of these hospital pharmacists, 47% came from hospitals of Punjab, 26% from Khyber Pakhtunkhwa, 13% from Sindh, 11% from Balochistan and 4% from Islamabad; 72% and 28% worked in tertiary and secondary hospitals, respectively. The majority (32%) interacted with shortages daily. The top three drug categories reported in shortage were oncology drugs (54%), cardiovascular drugs (53%) and antimicrobials (42%). 58% of the respondents have seen care delayed as a negative consequence of shortages. ‘Creating new communication system’ (65%) and ‘readjust budget plans’ (41%) were the two most frequently indicated recommendations for shortages management at hospital, while ‘circulars or alerts from the regulatory authority’ (60%) and ‘time to time directives from local health statuaries’ (48%) were two most widely suggested policy solutions.ConclusionDrug shortage is a serious concern in Pakistani hospitals, experienced on a daily basis endangering patients’ health. Enhanced communication is required, connecting the key stakeholders. Health policies should be reviewed; adequate funds should be allocated to the health sector preventing future shortages.

Managing acute agitation and aggression in the world of drug shortages

Acute agitation and aggression create safety risks for both patients and staff, often leading to psychiatric emergencies. Quick and appropriate treatment is necessary to achieve safe and effective outcomes. Unfortunately, there are several factors that hinder timely interventions, such as medication shortages and delay in staff preparedness. Ultimately, the goal of managing acute agitation and aggression in the clinical setting is to de-escalate the situation and prevent harm to patients and staff. This article will explore useful interventions in realizing treatment goals for the management of agitation and aggression in adults while navigating limitations faced in practice.

812. The Impact of Post-Operative Cephalexin on Surgical Site (SSI) Infections During a Cefazolin Shortage

Background Drug shortages directly impact patient care. Rates of drug shortages have declined except for antimicrobials, where shortage rates remain similar each year.1 In November 2018, a national cefazolin shortage occurred driving health systems to implement a therapeutic interchange of cefazolin for cephalexin for post-operative antimicrobial prophylaxis. The objective of this study is to determine whether SSI-rates change when post-operative cephalexin is used in placed of cefazolin. Methods This was a retrospective, observational cohort study of patients receiving post-operative antimicrobial prophylaxis at a community-based health system in Oregon and Washington between May 2018 – August 2019. Participants were divided into 3 periods for SSI-rate trend analysis: pre-shortage (May 2018 – October 2018), shortage (November 2018 – February 2019), and post-shortage (March 2019 – August 2019). The primary outcome was SSI-rates between groups. Results There were 6,378 patients in total (5,840 cefazolin vs. 538 cephalexin). There were no significant differences in baseline characteristics of age, sex, body mass index (BMI), or hospital location. The rate of SSI between pre-shortage and post-shortage cefazolin groups was not statistically different (14 [0.5%] vs. 23 [0.8%]; p=0.16). The primary outcome of SSI in the shortage group who received cephalexin was not statistically different (37 [0.6%] vs. 0 [0%]; p=0.07). Conclusion National drug shortages significantly impact patient care, often leading to seeking evidence-poor alternative medications. These results suggest cephalexin may be an acceptable post-operative prophylaxis antimicrobial if cefazolin is unavailable. Disclosures All Authors: No reported disclosures

Concept for the Urban Production of Pharmaceuticals to Compensate for Local Shortages

Long and complex supply chains are one of the main reasons for drug shortages. The COVID-19 pandemic and abrupt global lockdown have highlighted how precarious the global pharmaceutical market is. This paper presents a concept for pharmaceutical production in greenfield, urban and local areas as a way to mitigate drug shortages around the world. This approach represents a paradigm shift because the production of medicine tablets still happens mostly at big brownfield sites. The concept is based on the VDI 5200 guidelines and procedures used for factory planning at general production plants. The derived methodology takes three phases into account and enables the integration of continuous tablet manufacturing into urban areas to supply the local population with medicine.

Antiviral and antiretroviral drug shortages amidst COVID-19: How Africa is struggling

Antiviral drugs are of paramount importance in the accomplishment of the vision of zero new cases of COVID-19 globally, through sustainable retaliation against viral diseases. However, several challenges currently exist in Africa which include insufficient infrastructure, deteriorating health systems, and rising costs of healthcare delivery with concomitant rising inequity with regards to access to health services amid the COVID-19 pandemic. The pandemic itself has stimulated an increased use of phytotherapy in Africa as a result of essential drug shortages that have been attributed to a plethora of contributing factors such as travel restrictions, reduced per capita income as well as increased expenditure on transport. As a result, the paucity of antiviral along with antiretroviral drugs used to combat COVID-19 as well as several other endemic viral diseases in Africa has created a worrisome state. This article therefore discusses and aims to underscore the causes, effects, and implications of antiviral and antiretroviral shortages amid COVID-19 in Africa.

Creation of a State Drug Shortage Dashboard in the COVID-19 Pandemic

Purpose: Drug shortages are anticipated to worsen with time as the Coronavirus Disease 2019 (COVID-19) pandemic continues. The aim of this study is to track drug shortages within Illinois and identify causes and trends to this time-sensitive problem. Methods: In order to communicate between health systems within the state, the Illinois Council of Health-System Pharmacists (ICHP) developed a medication shortage dashboard, which collects information from health systems in the state on current drug shortages. Classes of medications inquired about included: anti-infectives, neuromuscular blocking agents (NMBAs), sedatives/analgesics, vasopressors, and “others.” Data was gathered from 6 different medication shortage dashboards, ranging from May 20, 2020 to June 22, 2020 and was used to track drug shortages within Illinois. Additionally, this data was analyzed in conjunction with the number of hospital beds utilized by COVID-19 patients at the time. Results: Illinois’s medication shortage dashboard tracked the supply level of 42 medications used in the treatment of patient’s hospitalized with COVID-19. Data from an average of 75 health systems was analyzed each week (average response rate: 52%). For each medication, health systems identified if they had ample supply, mild shortage, moderate shortage, or critical shortage. Overall the trends of these medications positively correlated with the number of hospital beds utilized by COVID-19 patients in Illinois ( r2 = 0.7). Conclusion: The data from this study supports the conclusion that increased hospital bed utilization by COVID-19 patients is correlated with increased drug shortages of medications used in the treatment of COVID-19. It is imperative that health systems take appropriate action to prevent and manage drug shortages.