Case Study Highlighting How Eastern Health faces Drug shortage - - PowerPoint PPT Presentation

Members of Eastern Health: Angliss Hospital, Box Hill Hospital, Healesville & District Hospital, Maroondah Hospital, Peter James Centre Turning Point Alcohol & Drug Centre Wantirna Health Yarra Ranges Health and Yarra Valley Community Health

Highlighting How Eastern Health faces Drug shortage challenges

Case Study

Dharam Singh Procurement Manager

Overview

• Analysing drug outages: a pain in the chain?
• Achieving better procurement outcomes from a

proactive approach

• Streamlining procurement processes in a

continuously changing environment

Sorry, “that cure is out of stock”

Definition

• Shortage-inability to supply medicines to where and when they are

needed.

• A supply issue requiring a change .It impacts patient care and requires

the use of an alternative agent (ASHP)

• An important principle of Australia’s national medicines policy is to

provide timely access of essential medicines to all Australians

• Medicine Shortages have become a complex global problem –with local

impact in Australia

Global Concern

• In light of growing concerns- the first ever gathering in Toronto in June 2013

‘‘International Summit on Medicine Shortages’ hosted by international Pharmaceutical federation’ and co-hosted by Canadian Pharmacist Association”

• The purpose was to provide a forum to discuss causes, impacts and solutions to global

issues

• One of the major recommendation of this summit was that each country should establish

a publicly accessible means of providing information on medicine shortages

• Therapeutic Goods Adminstration (TGA) website-in Australia
• There is evidence that these shortages are worsening with time, severity and no sign of

slowing down

What do we know in Australian Hospitals

• Often advised at short notice, most shortages were due to manufacture’s inability to

supply

• Identifying additional manufacturer’s who have capacity to initiate or increase

production of the drug in shortage

• It was identified majority of shortages were critical products, either life saving agents or

products with no therapeutic equivalence, single source

Financial and other reasons

• Drug outages are happening more regularly since 2007 and during and after the

global financial crisis (GFC) and no sign of slowing down

• Manufactures are conservative with their production forecast due to the fear of losses

due to expiry of products and capital investment

• According to data from Food and Drug Administration(FDA) the number of shortages

have risen steadily to all time high of 251 products in 2011

• The therapeutic classes of drugs in shortage included oncology drugs (28%)antibiotics

(13%) and electrolyte /nutrition drugs (11%)

Pristinamycin Story....(Case 1)

Indications-MRSA infections unresponsive or resistant to other agents-ref RMH 2013 This drug is not marketed in Australia but may be available under the SAS scheme- Last line therapy-Gram positive infections Start date –notification by distributor May 2014 End date- September 2014 Usage across EH- 180 packs of 16 tabs per month Action-Communicated to infection control physicians , tried all sources to secure stock but none available Impact – Cost increased $45.00 to $89.00 but was able to secure 100 packs before stock ran out EH response- No patients supply was affected though patients were inconvenienced interms of coming into hospital more regularly- weekly to receive rations

Consequences if product not available

• EH would need to admit 30 patients to administer iv medication –at a substantial cost
• Impact.... Cost, inconvenience for patients and relatives, risk if patient refused to come to

hospital and nursing staff would encounter - patient aggressive behaviour

• Options- not really viable
• Patient care- optimal therapy not available

Strategies to manage

• Achieve better procurement outcomes from a proactive approach in engaging

manufacturer's and enquiring if emergency supply available

• Medical information pharmacist may suggest options- alternative treatments and

engaging key stake holders- physicians, oncologists, clinical pharmacist, wholesalers, SAS suppliers, other key hospitals ie Austin, Peter MacCallum, Alfred , Cabrini, St Vincent's Public

• For oncology products –prioritise ie allocate stock to existing patients to complete

treatment cycle, do not start new patients

Strategies to manage (continued)

• Obtain substitutes in advance- obtain usage data from across all 5 eastern health

sites ,approximate ETA, SOH , product criticality - used for critical& emergency care assessed by formulary pharmacist

• Communication to all stakeholder’ s- expected duration of shortage and resolution
• f shortage

Strategies to manage (continued)

• Second line strategy to borrow from other hospitals-or in advance arrangements-

example Novoseven-used for major bleeding episodes SOH may not be enough

• Acquire unregistered products-(Special Access Scheme ) SAS – may be in different

languages-German, Japanese

• Safety risk- translation can be wrong or no translation at all
• Cost implications on pharmacy budget

Issues

• Shortages have created uncertainties and have major consequences for

pharmaceutical care-stockpiling

• Managing variability-supply versus demand
• Forecast errors
• Lack of communication –supply chain partners
• Lack of collaboration- manufacturer’s, wholesaler’s and hospitals

Eastern Health Response

• The major focus of most supply chain members is inventory cost and inventory

minimisation as well as improving efficiency

• However, inventory may not be the ultimate measure of performance when

dealing with people’s lives. For this reason, the pharmaceutical industry may need to focus more on minimizing the disruption of the supply of medicines than inventory minimisation

Message for the pharmaceutical Industry

Shortage Case 2

“There are the melphalan based transplants planned for February. And probably a couple more in March.. There are no alternatives to melphalan, and no alternative options for these patients. This could be a disaster for the patients.” Head of Hematology EH response-Acquired some emergency stock and borrowed some stock from PMCI It was enough for one patient . All patients were booked so this information was relayed to the manufacturer to reserve some stock If above fails than obtain SAS stock which is 7x the current price

Strategies to mitigate risks & concerns

Supply Assessment Risk Assessment Supplier Relationship & Development Inter-departmental communication – create awareness Relationship with other hospitals Hospital network collaboration Clinician engagement

What I have gained from the various experiences

• A proactive approach-working closely with all stakeholders-

greater sense of urgency

• Assessment of duration of shortage, identifying alternatives and

acquiring supplies –organizing early

• Contract agreements with manufacturers of critical products –

served better

• Adaptation of processes such as database to record shortages-

and creating a sense of urgency

• The tight hospital budgets pose challenges and Just in time (JIT)
• rder management limited safety stock