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 Force aims 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."