A current shortage of vitally needed medications is a dangerous situation being made worse by the COVID-19 pandemic. A new paper published online in the Annals of the American Thoracic Society examines this situation and provides recommendations on how clinicians and institutions might address potential scarcities of essential medications during the public health crisis.
The focus is on how federal and state governments, as well as healthcare providers, need to develop ethically sound policies that address already perilously low supplies of certain commonly-used medications, which are dwindling further due to resources needed to combat the coronavirus.
WHAT'S THE IMPACT
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Drug shortages have been a problem nationally for some time now, and the COVID-19 situation is only making matters worse. Some of the main issues are related to supply chain and the anticipated increase in ICU needs during the pandemic.
As of Thursday, the American Society of Health-system Pharmacists said there were 214 drug shortages in the U.S., which affects all patients. One medication that exemplifies this is Erwinia asparaginase, a chemotherapeutic agent for both children and adults with cancer.
Among medical specialties severely affected are oncology, critical care and infectious disease.
The authors said regional communication among hospitals is an important first step -- helping determine how local drug supply chains are affected -- and that coordination and sharing mechanisms are also critical.
This information sharing would ideally occur via a central repository or clearinghouse. Both the FDA and ASHP also maintain databases of current drug shortages, and independent healthcare companies maintain their own databases, which can provide invaluable information.
There are a number of barriers to this taking place -- among others, the need for cooperation among competing health systems, concerns about potential liability, and legal regulations that affect the transfer of drugs.
Communication should not be limited to discussions among pharmacists, hospitals and health systems; open discussions with patients who are most affected by drug shortages are essential. In the spirit of openness, the authors recommended that hospitals consider publicly posting information about drug shortages.
They also called on stakeholders, from governments to clinicians, to refocus some of their efforts in managing shortages of ventilators during the COVID-19 crisis to develop workflows and rationing criteria for essential medicines.
THE LARGER TREND
The rapidly escalating demand for medications due to COVID-19 is placing increased pressure on hospitals and health systems to appropriately manage drug inventory to support patient care. Essential medications used to alleviate breathing difficulties, relieve pain and sedate coronavirus patients are in short supply.
Because of this, healthcare organizations need inventory- and shortage-management strategies to weather the storm.
Historically acceptable levels – or "par" levels – simply won't be enough to meet the surge in demand, which can be four or five times the norm for certain drugs.