Collaborative Management Strategies for Drug Shortages in Neurocritical Care.

Drug shortages have become all too familiar in the health care environment, with over 200 drugs currently on shortage. In the wake of Hurricane Maria in September 2017, hospitals across the USA had to quickly and creatively adjust medication preparation and administration techniques in light of decreased availability of intravenous (IV) bags used for compounding a vast amount of medications. Amino acid preparations, essential for compounding parenteral nutrition, were also directly impacted by the hurricane. Upon realization of the impending drug shortages, hospitals resorted to alternative methods of drug administration, such as IV push routes, formulary substitutions, or alternative drug therapies in hopes of preserving the small supply of IV bags available and prioritizing them for them most critical needs. In some cases, alternative drug therapies were required, which increased the risk of medication errors due to the use of less-familiar treatment options. Clinical pharmacists rounding with medical teams provided essential, patient-specific drug regimen alternatives to help preserve a dwindling supply while ensuring use in the most critical cases. Drug shortages also frequently occur in the setting of manufacturing delays or discontinuation and drug recalls, with potential to negatively impact patient care. The seriousness of the drug shortage crisis reached public attention by December 2017, when political and pharmacy organizations called for response to the national drug shortage crisis. In this article, we review institutional mitigation strategies in response to drug shortages and discuss downstream effects of these shortages, focusing on medications commonly prescribed in neurocritical care patients.

Intravenous fluid delivery time improvement: application of cross-docking system.

PURPOSE: The cost of pharmaceutical supply chain due to drug waste is one of the current major issues in health care. Drug waste associated with intravenous (IV) fluid form of medication is one of the crucial issues for many pharmacies. The purpose of this paper is to apply a cross-docking model to minimize the IV delivery lead time to reduce drug waste by scheduling staff in a local hospital's inpatient pharmacy. DESIGN/METHODOLOGY/APPROACH: A mixed integer linear programming model is applied to the IV delivery system of a hospital. The parameters are selected based on the observations made in the inpatient pharmacy. FINDINGS: The result implies that cross-docking approach can be effectively applied to IV delivery system. In fact, the cross-docking optimization model employed in this case study reduces the IV delivery completion time of the inpatient pharmacy by 41 percent. RESEARCH LIMITATIONS/IMPLICATIONS: The scope of this research is limited to the activities performed after IV preparation. PRACTICAL IMPLICATIONS: The application of cross-docking system in staff scheduling will be beneficial for health care organizations that aim to minimize medication waste. ORIGINALITY/VALUE: The prime value of this study lies in the introduction of a cross-docking concept in an internal hospital ordering process. Cross-docking models are widely used in general supply chain systems; however, their application for specific activities inside hospitals is the novelty of this study, which can fill the research gap in terms of drug waste management within the inpatient pharmacy.