Managing medicines: Shortages of medicines

Last updated: Thursday, July 26, 2018

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 when a drug isn't available, a patient may be forced into non-compliance and a chronic condition deteriorates as a result. 
  2. Inconvenience – if they run out, patients may have to return to their doctor/pharmacist to get advice on how to manage the situation and/or to be prescribed an alternative drug. 
  3. Uncertainty – insufficient supplies of a medicine, or being prescribed an alternative, 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 potential 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). 

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 if their medicine is not available so it’s important to explain why a shortage has occurred, and how long it may last. If a shortage might mean switching to an alternative product, then what will this mean for the patient? A different method of administration, potentially new side effects, additional monitoring?

For medium to long-term shortages, pharmacists need to explain the situation to their community of prescribers, then help to identify suitable alternatives and advise on how best to prescribe them safely.

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