Hurricane Florence made landfall in North and South Carolina days ago, but Penn Medicine Hospitals and other facilities nationwide have planned for weeks to adapt to expected drug shortages associated with its path of destruction.
In 2017, Hurricane Maria drove through Puerto Rico, leaving in its wake immeasurable destruction and devastation, including production of saline I-V bags and other drugs. But, lessons learned from Maria, and countless hurricanes before it, are helping hospitals and pharmacies to become more savvy with their resources and plan ahead to anticipate shortages that could occur to ensure all patients receive their needed medications.
“When a hurricane hits, you never really know what the impact is going to be,” said Nishaminy Kasbekar, PharmD, director of pharmacy at Penn Presbyterian Medical Center (PPMC). “Hurricane Maria last year really helped us to now be more proactive and prepare for future natural disasters.”
Kasbekar, who is also on the Board of Directors of the American Society of Health – System Pharmacists (ASHP), says that this is a nationwide problem that is always top of mind for pharmacy colleagues and health systems across the nation.
While Hurricane Florence was downgraded to a category-1 shortly after reaching the North Carolina shores, the potential damage is not limited to the immediate effects of oppressive winds and rain that batter the Carolinas and Mid-Atlantic states. As coastal hospitals in South Carolina work to ensure their patients are safe, disaster planning here at home is focused on potential nationwide, long-term effects on adequate drug supplies, an effort that can often be a delicate balancing act.
Citing trade secrets and security concerns, drug manufacturers are not required by the Food and Drug Administration (FDA) to disclose what is produced in their facilities, which can make it more difficult to determine what drugs may experience a shortage.
“Last year, none of us had any idea that Puerto Rico was such a critical source of saline IV bags,” Kasbekar said. “Without swift action, all of a sudden, one day, your entire production line and supply for the next couple days could be gone without any guarantee that future orders would fill the void.”
In the case of Florence, Kasbekar says it appears that drug companies have made a renewed effort to be transparent, issuing statements with their contingency plans – which in some cases include shutting down operations for a few days – so pharmacists have a better idea of what’s ahead.
For example, at the Hospital of the University of Pennsylvania (HUP), pharmacists received notice of one shut down at a plant, and immediately worked to ensure an adequate supply of the products manufactured at that facility.
“We will continue our already close communication with our Nursing and Materials Management partners at the hospital in the case that an issue does arise,” said Danielle Auxer, PharmD, an associate director of Pharmacy at HUP, who echoed Kasbekar’s sentiment that companies are communicating more about production and distribution plans.
Drug shortages are affect many different types of drugs but ASHP says they are most commonly seen in injectable drugs, like morphine. Sometimes limits on availability arise from natural disasters and production quality issues; other times they are caused by policy changes – such as recent Pennsylvania efforts aimed at preventing prescription opioids from getting into the wrong hands. These external forces, among others, necessitate being nimble – sometimes at a moment’s notice.
These challenges have been a daily way of life for pharmacists and clinicians nationwide for years. Such concerns were expressed by Penn Medicine doctors in a letter in The New England Journal of Medicine, citing a 2012-2013 survey of cancer doctors in which 83 percent of those who regularly prescribe cancer drugs said that drug shortages prevented them from being able to give the ideal chemotherapy drug to their patients at least once in the previous six months.
At PPMC, a backorder advisory team meets weekly to discuss any present shortages reported by the FDA that influence how those drugs are distributed. For these shortages, and any that may arise associated with Hurricane Florence, the team discusses how to change doses, repackage drugs if specific sizes are not available for ordering, pool resources among Penn Medicine entities to make sure they are distributed most effectively, switch some IV drugs to oral versions, shift doses to patients who need them most critically – such as transplant and cancer patients – minimize waste, and make other changes to make sure all patients get the drugs they need.
Although the flow of operations is constantly in flux, multidisciplinary pharmacy and clinical care teams in all Penn Medicine hospitals make every effort to ensure patient care is the highest priority.
“We have been very creative and innovative in our solutions,” Kasbekar said. “We do physician education and nurse education to help get the word out. We have never had to say to a patient, ‘no, you cannot get this medicine you need because we don’t have it here.’”