[Primary care medicine in Germany at the crossroads]. / Primärmedizinische Versorgung in Deutschland am Scheideweg.

In addition to the existing social law options for primary care under medical responsibility for those with statutory health insurance, there are several projects to supplement the service structures: healthcare kiosks, primary care centers and community health nursing as well as general practitioner outpatient clinics in hospitals. These new projects amount to an institutionalization of services that were previously based at outpatient offices and partially to the transfer of medical services that were previously the responsibility of doctors to the responsibility of non-physician healthcare professionals, with additional financial outlay but without creating new care capacities. The constructs considered do not appear to be suitable for making a relevant contribution to compensating for the gap in doctors specialized in general or internal medicine and in other medical professionals in a demographically induced capacity phasing out process that is forecast to last until around 2036. The further development of German social law on primary care should instead focus on increasing the efficiency of resources which are becoming scarcer through guided and graduated access to doctors according to medical criteria.

Identifying Medicine Shortages With the Twitter Social Network: Retrospective Observational Study.

BACKGROUND: Early identification is critical for mitigating the impact of medicine shortages on patients. The internet, specifically social media, is an emerging source of health data. OBJECTIVE: This study aimed to explore whether a routine analysis of data from the Twitter social network can detect signals of a medicine shortage and serve as an early warning system and, if so, for which medicines or patient groups. METHODS: Medicine shortages between January 31 and December 1, 2019, were collected from the Dutch pharmacists' society's national catalog Royal Dutch Pharmacists Association (KNMP) Farmanco. Posts on these shortages were collected by searching for the name, the active pharmaceutical ingredient, or the first word of the brand name of the medicines in shortage. Posts were then selected based on relevant keywords that potentially indicated a shortage and the percentage of shortages with at least 1 post was calculated. The first posts per shortage were analyzed for their timing (median number of days, including the IQR) versus the national catalog, also stratified by disease and medicine characteristics. The content of the first post per shortage was analyzed descriptively for its reporting stakeholder and the nature of the post. RESULTS: Of the 341 medicine shortages, 102 (29.9%) were mentioned on Twitter. Of these 102 shortages, 18 (5.3% of the total) were mentioned prior to or simultaneous to publication by KNMP Farmanco. Only 4 (1.2%) of these were mentioned on Twitter more than 14 days before. On average, posts were published with a median delay of 37 (IQR 7-81) days to publication by KNMP Farmanco. Shortages mentioned on Twitter affected a greater number of patients and lasted longer than those that were not mentioned. We could not conclusively relate either the presence or absence on Twitter to a disease area or route of administration of the medicine in shortage. The first posts on the 102 shortages were mainly published by patients (n=51, 50.0%) and health care professionals (n=46, 45.1%). We identified 8 categories of nature of content. Sharing personal experience (n=44, 43.1%) was the most common category. CONCLUSIONS: The Twitter social network is not a suitable early warning system for medicine shortages. Twitter primarily echoes already-known information rather than spreads new information. However, Twitter or potentially any other social media platform provides the opportunity for future qualitative research in the increasingly important field of medicine shortages that investigates how a larger population of patients is affected by shortages.

[Lack of skilled medical personnel as a structural problem]. / Medizinischer Fachkräftemangel als strukturelles Problem.

The healthcare system in Germany is characterized by a comprehensive local patient care. Nevertheless, due to the increasing lack of medical personnel bottlenecks are impending, which are not only of a temporary nature. The increasing demography-related needs for care, insufficient healthcare competence of many people and the inadequate prevention will strengthen the demand for medical and nursing personnel. At the same time, physicians and nursing personnel from the high birth rate baby boomer years are leaving the healthcare system. This age cohort must now be replaced by a younger workforce; however, in Germany too few physicians are being trained when measured against the requirements. A marked increase in the number of university study places in medicine will not be able to alleviate the deficit in the short term but prospectively there is no way past an expansion of capacities. The decline in panel physicians, especially in general practitioner care, is accompanied by a clear increase of employees in the outpatient sector. The desire for reduced working hours is clearly recognizable throughout all age cohorts. The part-time quota is increasing. The discrepancy between desired and actual working times is largely underestimated. The increased part-time quota already shows that something must fundamentally change to be able to provide sufficient medical manpower and working hours for the treatment of patients. The association between increased part-time quota and dissatisfaction with the working situation in hospitals is obvious and has repercussions for the medical care. In a multifactorial process the causes and sequelae of bottlenecks in skilled personnel are mutually strengthened in a negative spiral. In the short term, the deficit in medical personnel can only be counteracted by a better cooperation between the outpatient and inpatient fields of care and by a massive reduction in bureaucracy. The digitalization can without doubt contribute to the relief of the healthcare system. Telemedical applications can improve the treatment in rural and structurally weak regions.

Influence of drug shortages on the well-being at work of pharmacists practicing in community pharmacies.

Introduction: The problem of drug shortages is not new, but it has reached unprecedented levels in recent years. In community pharmacies, pharmacists are forced to develop daily strategies to deal with such shortages and ensure patient care. These efforts result in significant constraints and adjustments to pharmacists' daily practices. The aim of this study is to explore the possible relationship between the consequences of drug shortages and the well-being of pharmacists in pharmacies. Material & method: This study adopts an exploratory qualitative approach by interviewing pharmacists working in community pharmacies in Wallonia. The data were collected between March and June 2023 through individual semi-structured interviews using a resolute guide. The interview guide was adapted as the interviews progressed and according to the pharmacists' views. 16 participants were included, including 7 owner pharmacists, 3 non-owners, and 6 non-titular pharmacists. The interviews were transcribed and then analyzed through a thematic approach. Results: An in-depth study of the day-to-day reality of pharmacies that is open to the public highlights the time-consuming nature of drug shortages, with various implications for pharmacists' relationships, finances, and workload. However, these professionals also highlight the recognition of patients when a solution is discovered, with some sources saying that shortages value the pharmacist's ability and enhance the profession. Finally, about the possibility of change in the training of pharmacists is also addressed by some pharmacists. Conclusion: Drug shortages demand changes in pharmaceutical practice and appear to affect the well-being of pharmacists in public settings. However, the impact seems complex and is amplified by the lack of personnel. With shortages continuing to rise in recent years, it would be wise to analyze the longer-term effects of this phenomenon.

Voices of the accelerated: key themes when considering implementation of an accelerated medical school program.

In this rapid communication, accelerated undergraduate medical education is examined using prior literature as well as experiences of those who have completed or are in the process of completing accelerated medical curricula. The Consortium of Accelerated Medical Pathway Programs (CAMPP) hosts an annual multi-institutional conference for all its members. During the meeting in July 2023, a virtual panel was convened from multiple constituent programs (N = 4) including medical students (N = 2), resident physicians (N = 4), and faculty (N = 2). Panel participants represented current learners or graduates from accelerated pathways of varying specialties (N = 5) to share firsthand experiences about acceleration to an audience representing over 25 medical schools. Five key themes were identified for accelerated students and trainees: Reduced debt as motivating factor to accelerate, Feeling prepared for residency, Ideal accelerated students are driven, Ability to form early professional relationships, and Less time for additional clinical experiences. Discourse from the CAMPP panel can inform current and developing accelerated programs at institutions looking to create or improve accelerated learning.

Leadership qualities faculty desire in academic leaders: An international Delphi study.

BACKGROUND: The global nursing workforce is confounded by shortages of nurses, faculty, and academic nursing leaders. Nursing academic leaders influence faculty recruitment and retention influencing the enrollment pipeline to fill nurse workforce capacity. OBJECTIVE: To identify leadership qualities nursing faculty prefer in nursing academic leaders globally. DESIGN: A multi-country exploratory design employed a three-round Delphi process including Demographic Data and open-ended questions. SETTING: An online Qualtrics survey was emailed to schools of nursing selected from seven global regions: United States (North America), Mexico (Latin America/ Caribbean), South Africa (Africa), Saudi Arabia (Middle East), Korea (Asia), Sweden (Europe), and Australia (Oceania). PARTICIPANTS: A convenience sample of faculty members employed in schools of nursing in the seven countries. METHOD: A 43-item Qualtrics survey developed from literature review of leadership qualities of nursing academic leaders was distributed to nursing faculty who participated in three Delphi rounds using descriptive statistics to analyze each round. Open-ended questions were analyzed using qualitative descriptive analysis. RESULTS: In Round 1, 54 faculty rated the 43 leadership qualities using a Likert Scale, identified the top 10, and added additional qualities not in the list. In Round 2, 26 of the original participants rated the resulting 29 leadership qualities. In Round 3, 16 of the original participants ranked their top 8 leadership qualities: mutual trust and respect; clear communication; creating a cohesive culture; assuring diversity, equity, and inclusivity; integrity; developing effective team structure; effective decision-making; and leading by example. In Round 3 participants rated nurses' preparedness for academic leadership. Open-ended questions identified 1) Strategies to prepare nurses for academic leadership roles and 2) Essential characteristics for effective academic leaders. CONCLUSION: Developing key leadership skills can increase the leadership capacity of nursing academic leaders, enhancing work environments, faculty recruitment and retention, helping mitigate a global challenge.

Reducing intravenous contrast utilization for CT: A health-system wide intervention with sustained impact.

OBJECTIVE: To determine the volume of intravenous iodinated contrast media utilized for CT before, during, and after the global iohexol shortage over a total of 17 months at a multisite health system. METHODS: This retrospective study included all patients who underwent CT at a large health system with 12 sites. Standardized contrast doses for 13 CT examinations were implemented 5/23/22. Mean contrast utilization per CT encounter was compared between 3 periods (pre-intervention 1/1/22-5/22/22; intervention 5/23/22-9/11/22; post-intervention 9/12/23-6/30/23). Contrast doses and CT encounter data were extracted from the enterprise data warehouse. Categorical variables were compared with a chi-squared test and continuous variables were compared with a two-tailed t-test. Multivariable linear regression assessed significance, with coefficients noted to determine magnitude and direction of effect. RESULTS: Pre-intervention, there were 152,009 examinations (87,722 with contrast, 57.7%), during the intervention 120,031 examinations (63,217 with contrast, 52.7%), and post-intervention 341,862 examinations (194,231 with contrast, 56.8%). Pre-intervention, mean contrast dose was 89.3 mL per exam, which decreased to 78.0 mL following standardization (Δ of -12.7%) (p<0.001). This decrease continued throughout the intervention and persisted in the post-intervention period (80.4 mL; Δ -10.0%, p<0.001). On multivariable analysis, patient weight, sex, and performing site were all associated with variations in contrast dose. Most but not all sites (9/12) sustained the decreased contrast media dose in the post-intervention period. DISCUSSION: Implementing standardized contrast media dosing for commonly performed CT examinations led to a rapid decrease in contrast media utilization which persisted over 1 year.

Pediatric Surgery Workforce Around the World: A Need to Revise Residency Programs?

Objectives:The study aimed to address the shortage of pediatric surgery specialists globally by investigating the discrepancies in training programs and population metrics across different countries and regions. Methods: An international survey of pediatric surgeons gathered data on training duration, examination procedures, certification, and population metrics like mortality rate and surgeon-to-population ratio. Results: The study included 44 countries. The average length of pediatric surgery training was 5.7 years, with no significant difference between different regions. The pediatric mortality rate and surgeons count per 100 000 people were inversely correlated, while training duration was associated with GDP and life expectancy, but not pediatric mortality rate or surgeons' count. Conclusion: Many countries' pediatric surgery training programs do not align with their actual need for pediatric surgeons. Nations with limited economic resources may opt to shorten residency programs or offer pediatric surgery as a direct specialty after medical school to mitigate the shortage effectively.

The Arduous Path Toward Equitable Access to Endocrinology Care.

Multiple factors contribute to the widening gap between supply and demand of endocrinology services. In addition to the inadequate growth of the workforce, the inefficient utilization of endocrinologists' expertise coupled with the rising prevalence of endocrine conditions has generated a crisis in access to specialty care. This mismatch is magnified in underserved communities and among certain racial/ethnic groups that carry a disproportionate burden of chronic diseases, like diabetes and osteoporosis, thus perpetuating the cycle of health disparities in vulnerable populations. Reorienting the framework of endocrine care toward more effective and equitable access will require comprehensive changes in operational processes, system-based policies, and in the diversity of our workforce. Specifically, the progressive transition to outcome-driven, team-based models of care can extend endocrinology services beyond the traditional boundaries of in-office referrals and promote job satisfaction. Further, the implementation of policies that directly tackle structural determinants of health is a prerequisite to a more precise and equitable deployment of specialty care. In this view, the recruitment and professional growth of clinicians underrepresented in medicine along the career ladder, including leadership roles, is a key conduit to revitalize our field and to innovate the delivery of endocrine care across all communities.

Policy Recommendations for Coordinated and Sustainable Growth of the Behavioral Health Workforce.

Policy Points Demand for behavioral health services outpaces the capacity of the existing workforce, and the unmet need for behavioral health services is expected to grow. This paper summarizes research and policy evidence demonstrating that the long-standing challenges that impede behavioral health workforce development and retention (i.e., low wages, high workloads, training gaps) are being replicated by growing efforts to expand the workforce through task-sharing delivery to nonspecialist behavioral health providers (e.g., peer specialists, promotores de salud). In this paper, we describe policy opportunities to sustain behavioral health workforce growth to meet demand while supporting fair wages, labor protections, and rigorous training.

The impact of meropenem shortage and post-prescription review and feedback on broad-spectrum antimicrobial use: An interrupted time-series analysis.

Background: Meropenem (MEPM) holds significance in treating severe infections and drug-resistant bacteria. There are concerns that antimicrobial shortages may lead to the use of alternative antimicrobials that are less effective and safer. We have responded to the MEPM shortage with post-prescription monitoring and feedback (PPRF) with no restrictions on MEPM initiation. We aimed to assess the impact of the MEPM shortage and the PPRF on broad-spectrum antimicrobial use and mortality. Methods: This retrospective study was conducted in a single hospital in Japan. The period from October 2021 to August 2022 was defined as the period before the MEPM shortage, and the period from September 2022 to March 2023 was defined as the period during the MEPM shortage. To support the appropriate use of antimicrobials during MEPM shortages, the antimicrobial stewardship team (AST) developed a list of alternatives to MEPM. An interrupted time series analysis was used to assess changes in use and mortality among patients receiving broad-spectrum antimicrobials over the study period. Discussion: The shortage of MEPM and PPRF temporarily increased the use of alternative cefepime; however, the subsequent change in days of therapy and days of coverage of broad-spectrum antimicrobials suggests a decrease in the use of these antimicrobials. Despite these shifts, the mortality rates remained stable, suggesting that the response to the shortage did not adversely affect treatment outcomes. Conclusion: In the context of antimicrobial shortages, AST support plays an important role in enabling physicians to make optimal use of antimicrobials.

Draft Guideline for Industry to Manage Drug Shortages in Japan.

The increasing global drug shortage poses a substantial challenge to national healthcare systems and affects access to essential therapies. In Japan, this problem is exacerbated by a large-scale government campaign to switch from brand-name products to generic drugs and manufacturing/marketing authorization holders with poor development and manufacturing controls. Regulatory bodies, such as the U.S. Food and Drug Administration and the European Medicines Agency have developed guidelines aimed at ensuring continuous drug supply and mitigating manufacturing risks. However, Japan's efforts have primarily relied on voluntary industry guidelines, lacking the robust regulatory frameworks of other developed nations. Therefore, this study proposes a draft guideline for Japan's pharmaceutical industry to manage drug shortages effectively. The Japanese government needs to establish a framework system that will enable pharmaceutical companies to effectively maintain a stable supply based on the proposals developed in this study.

Transfer of internationally qualified nurses' specialty skills to developed countries after immigration: A multicentre policy review.

BACKGROUND: Internationally qualified nurses are highly sought after as a labour source due to continued shortages in the nursing profession in most developed countries. However, the lack of clear policies and procedures for nurses in the host country to use specialty nursing skills can result in the underutilisation of their expertise. OBJECTIVES: To review the registration processes of internationally qualified nurses in 20 developed countries, with a focus on the transferability of specialised skills gained overseas. METHODS: A multicentre policy review design was used, using the STROBE reporting guidelines. The study sourced policy information from nurse registration bodies in developed countries and reviewed and removed redundant policies. RESULTS: Out of 34 policies initially identified, 26 were used to show the registration process of nurses after immigration to developed countries. Only four of the 20 countries reviewed indicated the option of specialised nurse registration on their website for internationally qualified nurses, with a university qualification required before years of experience. All other countries indicated the general registration pathway only. IMPLICATIONS FOR NURSING POLICY: More attention is needed to address the lack of well-defined policies that guide the utilisation of internationally qualified nurses' specialised skills. Transparent procedures are essential to fully benefit from their expertise in the host country's health workforce.

Workforce estimate to treat mental disorders in the Kingdom of Saudi Arabia.

BACKGROUND: Mental, neurological, and substance abuse (MNS) disorders describe a range of conditions that affect the brain and cause distress or functional impairment. In the Middle East and North Africa (MENA), MNS disorders make up 10.88 percent of the burden of disease as measured in disability-adjusted life years. The Kingdom of Saudi Arabia (KSA) is one of the main providers of mental health services and one of the largest contributors to mental health research in the region. Within the past decade, mental health resources and services has increased. METHODS: We employ a needs-based workforce estimate as a planning exercise to arrive at the total number of psychiatrists, nurses, and psychosocial care providers needed to meet the epidemiological need of mental health conditions of the population of KSA. Estimates for a potential mental health workforce gap were calculated using five steps: Step 1-Quantify target population for priority mental health conditions. Step 2-Identify number of expected cases per year. Step 3-Set target service coverage for each condition. Step 4-Estimate cost-effective health care service resource utilization for each condition. Step 5-Estimate service resources needed for each condition. RESULTS: The planning exercise indicates an epidemiologic need for a total of 17,100 full-time-equivalent (FTE) health care providers to treat priority MNS disorders. KSA appears to have a need-based shortage of 10,400 health workers to treat mental disorders. A total of 100 psychiatrists, 5700 nurses, and 4500 psychosocial care providers would be additionally needed (that is, above and beyond current levels) to address the priority mental health conditions. The shortfall is particularly severe for nurses and psychosocial workers who make up 98.9 percent of the shortfall. This shortage is substantial when compared to other high-income countries. Overall, the workforce needed to treat MNS conditions translates to 49.2 health workers per 100,000 population. CONCLUSION: Challenges to addressing the shortfall are Saudi specific which includes awareness of cultural customs and norms in the medical setting. These challenges are compounded by the lack of Saudi nationals in the mental health workforce. Saudi nationals make up 29.5 percent of the physician workforce and 38.8 percent of the nursing workforce. Policymakers and planners supplement this shortfall with non-Saudi providers, who must be mindful of Saudi-specific cultural considerations. Potential solutions to reducing the shortfall of mental health care workers includes nurse task shifting and training of general practitioners to screen for, and treat, a subset of MNS disorders.

Intravesical Gemcitabine and Docetaxel Therapy for BCG-Naïve Patients: A Promising Approach to Non-Muscle Invasive Bladder Cancer.

Bacillus Calmette-Guérin (BCG) therapy for patients with non-muscle invasive bladder cancer (NMIBC) faces limitations in efficacy and significant side effects, aggravated by a recent global shortage. In this prospective clinical study, we report the outcomes of sequential intravesical administration of gemcitabine and docetaxel (Gem/Doce) as a first-line treatment for BCG-naïve patients with high-risk NMIBC (HR NMIBC). From October 2019 until April 2022, we enrolled 52 patients and followed the treatment protocol set forth by the University of Iowa. Follow-up assessments were conducted every 3 months. In this cohort, 25 (48.1%) patients were diagnosed with high-grade T1 (T1HG) bladder cancer, 10 (19.2%) patients had carcinoma in situ (CIS), and 17 (32.7%) patients had a combination of T1HG+CIS. The median time to first recurrence in the T1HG, CIS, and T1HG+CIS groups was 11, 10.5, and 8.8 months, respectively. The recurrence-free survival was 98.1%, 94.2%, and 80.8% at 6, 9, and 12 months, respectively. The rate of progression-free survival was 100%, 98.1%, and 92.3% at 6, 9, and 12 months, respectively. We demonstrated the safety and efficacy of Gem/Doce therapy in BCG-naïve patients with HR NMIBC during a one-year follow-up. Further research with extended follow-ups, as well as direct comparisons of Gem/Doce with other anticancer agents, is essential.

Providing care in underresourced areas: contribution of the physician assistant/associate workforce.

BACKGROUND: Prior studies suggest that physician assistants/associates (PAs) are more likely than physicians to work in underresourced areas. However, data characterizing the current PA workforce in health professional shortage areas (HPSAs) and medically underserved areas (MUAs) are lacking. METHODS: We analyzed the 2022 cross-sectional dataset from a comprehensive national database to examine the demographic and practice characteristics of PAs working in HPSAs/MUAs compared to those in other settings. Analyses included descriptive and bivariate statistics, along with multivariate logistic regression. RESULTS: Nearly 23% of PAs reported practicing in HPSAs/MUAs. Among PAs in HPSAs/MUAs, over a third (34.6%) work in primary care settings, 33.3% identify as men, 15.6% reside in rural/isolated areas, and 14.0% are from an underrepresented in medicine (URiM) background. Factors associated with higher odds of practicing in a HPSA/MUA included residing in rural/isolated settings, URiM background, and speaking a language other than English with patients. CONCLUSIONS: As the PA profession grows, knowledge of these attributes may help inform efforts to expand PA workforce contributions to address provider shortages.

Dialysis nurse demand in Europe: an estimated prediction based on modelling.

Background: To estimate the projections of supply and demand for dialysis nurses (DNs) over 5 years in four European countries (France, Italy, Spain and the UK). Methods: This study modelled the nursing labour workforce across each jurisdiction by estimating the current nursing labour force, number of nursing graduates and the attrition rate. Results: France currently has the greatest demand for DNs (51 325 patients on dialysis), followed by Italy, the UK and Spain with 40 661, 30 301 and 28 007 patients on dialysis, respectively. The number of in-centre haemodialysis (HD) patients is expected to increase in the four countries, while the number of patients on home HD (HHD) or on peritoneal dialysis (PD) is expected to increase in the UK. Currently Italy has the greatest proportion of DNs (2.6%), followed by France (2.1%), Spain (1.7%) and the UK (1.5%). Estimation of the dialysis nursing staff growth rate over 5 years showed that the UK has the greatest estimated growth rate (6%), followed by Italy (2%), France (2%) and Spain (1%). Conclusions: Dialysis demand will increase in the coming years, which may exacerbate the DN shortage. Additionally, competencies and training requirements of DNs should be precisely defined. Finally, implementing and facilitating PD and HHD strategies would be helpful for patients, healthcare professionals and healthcare systems and can even help ease the DN shortage.

Experiences of healthcare providers and caregivers regarding health system bottlenecks affecting child healthcare service delivery in a rural district: Empirical qualitative study.

AIM: To explore the experiences of nurses and caregivers about the health system bottlenecks to the delivery of child healthcare services in a rural district in Ghana. DESIGN: The study employed a qualitative approach using an exploratory, descriptive design. METHODS: Collection of data was through semi-structured, face-to-face interviews with 26 participants in the Nkwanta South Municipality, Ghana. Audio recordings of interviews were transcribed verbatim and analysed qualitatively. Inductive codes generated were organised into themes and sub-themes. RESULTS: The main health system bottlenecks that emerged were the poor state of in-patient facilities, inadequate basic logistics and persistent shortage of essential medicines needed for child healthcare delivery. CONCLUSIONS: Health system bottlenecks have the tendency to affect the treatment and hospitalisation outcomes of sick children and eventually impact the state of child healthcare negatively. Concerted efforts by government and local authorities to remove these barriers will help to improve child health and child health outcomes. PUBLIC CONTRIBUTION: A total of 26 participants comprising nurses and caregivers, agreed and participated in this study. Interviews with these participants were conducts either in the health facilities or in the communities where they live. Their responses contributed significantly to the content of this article.

Managing drug shortages in pediatric care.

The global impact of drug shortages on healthcare systems is a concerning issue that needs urgent attention. These shortages not only jeopardize patient care, public health, and healthcare delivery but also pose distinct challenges for pediatric populations due to their specific medication requirements and vulnerabilities. It is imperative to address this issue to safeguard the health and wellbeing of this specific age group. This review Gaimed to conduct a systematic analysis of strategies for addressing drug shortages in pediatric care from 2014 to 2024. The search included five databases: PubMed, Reaxys, Embase, Scopus, and Science Direct, using the keywords "drug shortage" and "pediatric". The final protocol was developed following the guidelines outlined in the " The PRISMA 2020 statement: An updated guideline for reporting systematic reviews". In total, 234 publications were identified. After screening the search results and applying inclusion and exclusion measures, a total of 27 original research papers were included. The primary finding indicates that a comprehensive approach rooted in risk management can significantly mitigate drug shortages in pediatric settings. This approach should address underlying causes such as manufacturer and delivery challenges and focus on prevention through enhanced forecasting and vigilant shortage monitoring. The most prevalent response involved seeking alternative treatment options. It is imperative to implement institutional and national guidelines, foster communication, and provider education, and minimize waste to effectively mitigate drug shortages in pediatric settings.