Managing medicines: Shortages of medicines

Last updated: Thursday, February 18, 2016

A shortage of a medicine can cause significant problems for patients. So, an important role for pharmacists is to manage these situations – both for individual patients who are affected, and at an organisational level for e.g. a whole hospital. For patients, shortages can potentially lead to:

  1. Harm – by missing doses, a patient may be forced into non-compliance so that a chronic condition deteriorates. 
  2. Inconvenience – patients may have to return to hospital or visit their GP to get further supplies when they run out. 
  3. Uncertainty – insufficient supplies of a medicine may confuse the patient or cause anxiety about long-term management of a medical condition. 
  4. Dissatisfaction – understandably, patients may be dissatisfied if they can’t obtain a medicine they need. 

Reasons for shortages 

There are many reasons for shortages of medicines. Some can be caused by the hospital, some are outside of a hospital’s control. They include:

1. Hospital-related reasons 

  • Poor stock management (e.g. stock ordering levels are wrong; rarely used medicines have expired by the time they’re needed; a medicine that’s been recently added to the formulary has not yet been ordered in as stock). 
  • Predictable increased local usage but Pharmacy Stores have not been informed (e.g. a change in policy towards use of a medicine; several patients suddenly receiving same drug). 

2. Reasons outside hospital’s control

  • Regulatory (e.g. the latest batch of a medicine fails quality assurance; drug recall; new manufacturing standards lead to a manufacturing delay while they are implemented). 
  • Product discontinued by manufacturer. 
  • Manufacturing failure (e.g. catastrophe at factory; raw materials shortage). 
  • Increased demand (e.g. evidence-based change in practice, or sudden change to use of an infrequently used product due to shortage of the first-line choice). 

Managing shortages 

A patient may be worried in this situation, so it’s really important to explain to him or her why a shortage has occurred, how it will affect them, and for how long. You should apologise if it’s the hospital’s fault. A shortage might mean temporarily or permanently switching to an alternative product. What will this mean for the patient: a different method of administration, new side effects, additional monitoring?

Across the whole hospital, Pharmacy needs to communicate with doctors and nurses and exercise leadership in identifying the best alternatives when a medicine is not available. Pharmacists can then advise how best to prescribe any alternatives safely.

You can read more about why shortages occur in this really helpful Drug and Therapeutics Bulletin 2015;53:33-36. For more guidance on managing medicines shortages in secondary care, refer to the Royal Pharmaceutical Society's Best Practice Standards for England.

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