When a drug is in short supply at Beth Israel Deaconess Medical Center in Boston, a message goes out to the physicians on the hospital’s intranet system. When the shortage gets close to being critically short in supply, a message will be embedded into the physician order-entry system recommending that the physicians use an alternate drug—if there is an alternate.
It’s an alert system that has been put to frequent use lately, says Joseph Li, MD, SFHM, director of the hospital medicine program at Beth Israel Deaconess, associate professor of medicine at Harvard Medical School, and president of SHM.
The rate of drug shortages has been rising steadily in recent years due to quality questions at manufacturers, consolidation in the drug-manufacturing industry, and other factors, according to data from the U.S. Food and Drug Administration and other sources.
“It does seem like there’s more today than previous years,” says Dr. Li, who was a pharmacist before he trained in internal medicine.
Some of the recent shortages at Beth Israel Deaconess have involved the diuretic furosemide, the antiemetic Compazine, and the anticoagulant heparin. “More often than not, there’s a reasonable alternative that can be chosen,” he says. “Not necessarily exactly the same drug, but usually in the same therapeutic class.”
While actual cases of patient harm due to drug shortages appear to be relatively uncommon, having drugs in short supply can lead to a safety problem hovering over a medical center and its hospitalists. In addition to the potential of simply not having an alternate to give to a patient, hospitalists and their pharmacists sometimes have to adjust to a new dosage that comes with a replacement medication.
Plus, having to manage the problem when a drug shortage hits can be a headache, with time and resources spent trying to obtain updates from drug manufacturers and find other drugs that can be used in the meantime, experts say.
With hospitalists now treating so many patients, many of them complex and on multiple medications, it is an important issue for hospitalists to stay aware of and to be prepared for, Dr. Li says. More than 90% of all medical patients at Beth Israel Deaconess are now cared for by hospitalists, he says, and it’s a similar situation for many acute-care hospitals around the country.