Medicines Shortages

The problem

Problems caused by medicines shortages are serious, threaten patient care in hospitals and require urgent action.

Medicines are not simple items of commerce, they are an essential component of patient care and in the hospital sector they must be administered to the patient in a timely manner. This is particularly the case for patients taking medicines which have a significant clinical consequence when doses are missed, such as anti-psychotics, anti-epileptics, immunosuppressives and anti-cancer drugs.

Shortages of such medicine place the ability to provide timely administration of a particular medicine under threat.

Managing medicines shortages and ensuring continuity of supply can also cause the diversion of significant amounts of the time and attention of a hospital pharmacist from other tasks important in the provision of high quality, safe and efficacious care.

Furthermore, the medicines shortage problem can undermine efforts to reduce costs in health systems as often, in the case of shortage, a more costly alternative must be used – or worse, a less effective alternative.

EAHP's 2014 survey of the medicines shortage problem

EAHP's 2014 survey of medicines shortages in European hospitals was the largest investigation of its kind, with over 600 responses from 36 European countries.

Headline findings include:

  • 86% of hospital pharmacists reported that medicines shortages are a current problem in the hospital they work in, in terms of providing the best care to patients and/or operating the hospital pharmacy
  • 66% of respondents said that medicines shortages affect their hospital pharmacy on a daily or weekly basis
  • Antimicrobial agents, oncology products, emergency medicines, cardiovascular medicines and anaesthetic agents are the top affected 
  • 75.4% of hospital pharmacists either agreed or stongly agreed with the statement "medicines shortages in my hospital are having a negative impact on patient care."
  • 63% of hospital pharmacists estimate that the typical medicines shortage normally lasts for a number of weeks
  • Reported impacts for patients include delayed or interrupted chemotherapy treatment, unnecessary experience by patients of side effects, heightened clostridium difficile risk and deterioration in patients' conditions. 

Full report HERE.

Press release HERE.

Infographic HERE 

Video HERE.

EAHP's 2013 survey of the medicines shortage problem

A previous survey of EAHP's membership on the shortages topic received over 300 responses from 27 countries. Headline results included:

  • 99% of hospital pharmacists in Europe have experienced shortage problems in the last year
  • 63% of hospital pharmacists report medicines shortages to be a weekly, sometimes daily, occurrence
  • 77% consider the problem has become worse over the past year.

A booklet (June 2013), setting out the results in more detail, is available here.

Solutions

Each part of the supply chain has responsibilies.

For prescribers:

  • to be aware of the problem;
  • to discuss with hospital pharmacists potential changes to prescribing policies if necessary; and,
  • to take due notice of hospital pharmacy communications on the issue

For hospital pharmacists:

  • to be vigilant and alert to the issue of medicines shortage;
  • to share relevant information of forthcoming shortages with colleagues, including hospital management and prescribers;
  • use, and keep up to date, pharmacy skills to identify other solutions when a shortage occurs, which might eventually include small scale production of medicine without a marketing authorisation; and,
  • consider contingency arrangements for theoretical shortages.

For wholesalers:

  • communicate effectively to hospital pharmacies about likely and current shortages, and in a timely manner;
  • make appropriate use of quotas as a tool to ensure fair distribution when demand exceeds supply; and,
  • prioritise replenishment of supplies over routine delivery when a shortage is relieved.

For manufacturers:

  • provide adequate notice and alert of manufacturing problems;
  • provide within such notifications information on how imminent the shortage is, the expected duration of the shortage, whether alternatives are available, and the size of the manufacturer’s share of the market for the product;
  • provide active assistance to hospital pharmacies in the management of shortage problems, such as maintaining dedicated helplines;
  • ensure maintenance of adequate “buffer stocks” of medicines, especially for critical medicines such as those used by emergency departments in hospitals;
  • conduct customer audits and surveys to assess the performance of supply arrangements and to identify any potential improvements; and
  • otherwise work with urgency to bring to an end the shortage difficulties currently being experienced across Europe, including route cause analysis of why the problems are occurring and how they might be resolved most quickly.

Further investigation required

EAHP also consider that due to the scale of the problem, its cross-border nature, its impacts on patient care and its relationship to EU law, a European investigation of the problem involving the European Commission, European Medicines Agency, and European Heads of Medicines Agencies, is required.

See the full EAHP statement here 

Recent Developments

 

Last update: 26 February 2015