Newly published survey shows drug shortages still have major impact on patient care

January 09, 2014

According to newly published results from a survey of pharmacy directors, drug shortages remain a serious problem for patient safety. Nearly half of the responding directors reported adverse events at their facilities due to drug shortages, including patient deaths.

The survey was conducted by Northwestern Medicine® researchers in partnership with MedAssets, as part of the MedAssets Pharmacy Coalition to better understand how drug shortages affect patient outcomes. The survey asked pharmacy directors from a variety of health care settings to supply information on drug shortage related patient complaints, adverse events, medication errors, patient outcomes, demographics and institutional costs. The survey's findings were detailed in, "Effects on Patient Care Caused by Drug Shortages: A Survey," a research article published in the November/December issue of the Journal of Managed Care Pharmacy (JMCP).

"Drug shortages are the first thing I think about when I get up in the morning and it is the last thing on my mind when I go to bed at night," said Gary Fennessy, MBA, vice president of Operations for Northwestern Memorial HealthCare and co-author of the JMCP article. "This is not a problem that is going to go away on its own. Healthcare leaders must not lose sight of it as a major contributor to patient harm or consider its adverse effects inevitable."

In 2009, the American Society of Health-System Pharmacists put drug shortage management guidelines in place for health care providers to try and minimize negative impacts patient care, and in 2011, following an Executive Order from President Barak Obama on reducing drug shortages, the U.S. Food and Drug Administration (FDA) increased its efforts to prevent and resolve drugs shortages. While the FDA recently reported that the number of new shortages in 2012 was down to 117, from 251 in 2011, drug shortages are still having a major impact on patient care.

A common practice to help mitigate the problems caused by a drug shortage is to use an alternative medication when possible. Even when alternate medication can be used, there can be many unintended consequences and additional side effects. In general, drug shortages have been known to cause, or contribute to a variety of issues, which were also represented in the newly published survey responses including: In addition to the more well-known impacts, the new JMCP article revealed that nearly 10 percent of the reported adverse patient outcomes were increased readmissions due to drug shortage related treatment failures. Thirty eight percent of the surveyed pharmacy directors also said their organization had received at least one patient complaint related to shortages, and of those respondents reporting the actual number of patient complaints about 20 percent reported a total of more than 10 complaints. The article's authors suggest that documented occurrence of increased readmission rates and the impact of drug shortage related patient complaints could affect health care reimbursements for providers in the future as part of the Affordable Care Act.

"This survey is the first that we are aware of to describe the effects that drug shortages have on patient complaints," said Despina Kotis, PharmD, director of pharmacy at Northwestern Memorial HealthCare and co-author of the JMCP article. "It clearly shows that patients are aware these shortages are happening and they are upset that their care is being adversely affected by them."

"Drug shortages have been a well known issue in patient care for nearly a decade," said Milena McLaughlin, PharmD, MSc, clinical pharmacist at Northwestern Memorial Hospital, assistant professor at the Midwestern University Chicago College of Pharmacy, and lead author of the JMCP article. "While some progress has been made, drug shortages continue to be problematic and our results help make it clear that this is still a major area for improvement in patient care."
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The authors of the research article are: Milena McLaughlin, PharmD, MSc (Northwestern Medicine and Midwestern University Chicago College of Pharmacy); Despina Kotis, PharmD, (Northwestern Medicine); Kenneth Thomson, MBA (MedAssets); Michael Harrison, BS (MedAssets); Gary Fennessy, MBA (Northwestern Medicine); Michael Postelnick, BS (Northwestern Medicine); and Marc H. Scheetz, PharmD, MSc (Northwestern Medicine and Midwestern University Chicago College of Pharmacy).

The MedAssets Pharmacy Coalition is comprised of individuals from several healthcare organizations and areas including acute care, non-acute care, management and industry. The Coalition was originally formed to discuss the appropriate use of medications, and then with the rising number of drugs shortages changed its focus to finding out how drug shortages affected patient outcomes.

About Northwestern Medicine®

Northwestern Medicine® is the collaboration between Northwestern Memorial HealthCare and Northwestern University Feinberg School of Medicine around a strategic vision to transform the future of healthcare. It encompasses the research, teaching and patient care activities of the academic medical center. Sharing a commitment to superior quality, academic excellence and patient safety, the organizations within Northwestern Medicine comprise more than 9,000 clinical and administrative staff, 3,100 medical and science faculty and 700 students. The entities involved in Northwestern Medicine remain separate organizations. Northwestern Medicine is a trademark of Northwestern Memorial HealthCare and is used by Northwestern University.

About Northwestern Memorial Hospital

Northwestern Memorial is one of the country's premier academic medical center hospitals and is the primary teaching hospital of the Northwestern University Feinberg School of Medicine. Along with its Prentice Women's Hospital and Stone Institute of Psychiatry, the hospital has 1,705 affiliated physicians and 6,769 employees. Northwestern Memorial is recognized for providing exemplary patient care and state-of-the art advancements in the areas of cardiovascular care; women's health; oncology; neurology and neurosurgery; solid organ and soft tissue transplants and orthopaedics.

Northwestern Memorial has nursing Magnet Status, the nation's highest recognition for patient care and nursing excellence. Northwestern Memorial ranks 6th in the nation in the U.S. News & World Report 2013-14 Honor Roll of America's Best Hospitals. The hospital is recognized in 14 of 16 clinical specialties rated by U.S. News and is No. 1 in Illinois and Chicago in U.S. News' 2013-14 state and metro rankings, respectively. For 14 years running, Northwestern Memorial has been rated among the "100 Best Companies for Working Mothers" guide by Working Mother magazine. The hospital is a recipient of the prestigious National Quality Health Care Award and has been chosen by Chicagoans as the Consumer Choice according to the National Research Corporation's annual survey for 15 consecutive years.

About MedAssets

MedAssets (NASDAQ: MDAS) is a healthcare performance improvement company focused on helping providers realize financial and operational gains so that they can sustainably serve the needs of their community. More than 4,200 hospitals and 122,000 non-acute healthcare providers currently use the company's evidence-based solutions, best practice processes and analytics to help reduce the total cost of care, enhance operational efficiency, align clinical delivery, and improve revenue performance across the are continuum. For more information, please visit http://www.medassets.com.

Northwestern Memorial HealthCare

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