EFFECTIVE DATE: 5/01 REVIEW DATE: 12/04
POLICY EDITION: 01 REVISION DATE: 12/01
WISHARD MEMORIAL HOSPITAL POLICY MANUAL
DEPARTMENT: Pharmacy Services POLICY NUMBER: 731-416
POLICY TITLE: Identifying and Managing SUBJECT: Drug shortages Drug Shortages
To establish guidelines and procedures for managing drug shortages for Wishard Health Services.
The Department of Pharmacy will have guidelines to safely manage drug shortages.
I. Find out about drug shortages
The Inventory Pharmacist will regularly search web sites for drug shortage information and will obtain information from Wholesalers.
Obtain pertinent information
Inventory Staff will contact the manufacturer for information, a release date,
and directions for ordering drugs on allocation or for emergency supplies.
Current inventory will be evaluated to determine if quantity is
sufficient. If not, inventory
staff will try to obtain an alternative from another supplier/wholesaler or
order allocated or emergency supplies directly from manufacturer.
A current list is kept to check drug shortage stock and to reorder at
the appropriate intervals.
Identify usage and
A Clinical Specialist, for extreme and/or extended shortages, will undertake any or all of the following steps:
- identify clinically appropriate uses of the drug
- ascertain use of the drug in our hospital
- develop strategies to decrease drug waste
- determine alternative products
- prioritize use
Place limitations on use
on the extent of the shortage, availability of alternatives, and our
institutions usage, a Clinical Specialist or designee will develop plans to
restrict use and reduce wastage. Plans
may include: medication removal from floor stock, A Proof-of-Use@
sheet dispensing, unit dose dispensing, alternative product usage.
Educate departments and
Clinical Specialist will alert departments to the drug shortage (and
reason/duration if known), possible substitutes with dosing information, and any
other action plans or recommendations via Pharm-a-gram and/or Memorandum, add
information in the gopher drug entry system when appropriate.
Pharmacy Staff is informed of drug shortages along with recommendations
at staff meetings, Pharm-A-Grams and/or memorandums.
A Drug Shortage Notebook is updated and kept at the Inpatient Pharmacy
Unit Dose Desk.
Monitor Adverse Effects
Adverse effects from alternatives used because of drug shortages will be monitored through ADR reports, and errors through Medication Error Subcommittee and will be reported quarterly to Pharmacy and Therapeutics Committee.
Director of Pharmacy
Chairman Pharmacy and Therapeutics Committee