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Battling the Hurricane-Driven Drug Shortages

What ASCs can do to stay ahead of the curve

BY SAHELY MUKERJI |  OCTOBER 2017

Hurricane Maria devastated Puerto Rico last month and disrupted the production of several drugs and medical supplies, including IV solutions. While the US Food and Drug Administration (FDA) is working with companies, such as Baxter International, to alleviate the shortages, ASCs could take a few steps to manage the shortages effectively.

“While there is no magic bullet, there are some strategies that might help mitigate the gap of needs versus supply,” says Sheldon Sones, president of Sheldon Sones and Associates in Newington, Connecticut. “Our concerns in wake of the disasters evolving in Puerto Rico focus on intravenous solutions as well as frequently used antibiotics such as cefazolin.”

Pro-active Measures

One of the best ways for an ASC to manage a drug shortage is to take steps to prepare when no shortages exist, Sones says. As a first step he recommends cultivating good relationships.

“I have suggested to our facilities throughout the year, as we have experienced intermittent shortages of routinely-used drugs and solutions, to establish relationships with several wholesalers,” he says. “These should be active relationships and not activated during shortages solely. Relationships that are used in that manner are generally unsuccessful.”

Rochele Hovasse, chief operating officer of Audubon Surgery Center and Audubon ASC in St. Francis, Colorado Springs, suggests having good relations with local hospitals and pharmacies as well.

“We have a strong relationship with our local hospital, so if we go low on a certain drug, the hospital shares it with us because the hospital gets its supplies before the ASCs do,” she says. “We also have good relations with our distributor and vendor. Our distributor representative gave us a warning about the possible shortages. So, as soon as Hurricane Maria even started tracking, we could place a large order of inner stem implants for our urology division. Our vendors also are in constant contact with the manufacturers, and they gather information and let us know about possible shortages. We reach out to them as well.”

Darlene Vortherms, chief executive officer of PurNet Inc. of Worthington, Minnesota, says her company notifies its more than 2,000 members as soon as it gets notification of a possible shortage from the big industries.

“We work with many distributors,” she says. “When our members cannot get their supplies that they have already placed orders on, we shop for them. We even go through other distributors that are not our main distributor.” Given that her company has no contract pricing with those other distributors, price gouging could occur, she says.

As a second pre-emptive measure, Vortherms suggests stocking up. Hovasse says she balances her ASC’s inventory and stock levels all through the year. “It is a juggle. We prepare for the winter in Colorado,” she says. “Monument Hill [a mountain pass in central Colorado] can shut down because of weather, so for spike seasons, we overstock for seasonal products. Look at your case mix to determine the level and the types of stock you should have on hand.”

Reactive Measures

As soon as a shortage becomes evident, first off, “the facility medical staff leadership in concert with the pharmacy consultant, should preemptively discuss formulary alternatives for drugs,” Sones suggests.

“Look for alternative and substitute products,” Hovasse says. “You might also want to look at other units of measures that you do not typically use. Look at all distributors: primary, secondary and local. As a one-stop shop, PurNet is a national purchasing network that makes numerous calls on our behalf to various manufacturers and distributors for the products in shortage and alternatives.”

Vortherms says, “We call all the other distributors who might be able to beg, borrow or steal. However, ASCs might want to be prepared to get to a point where they have to perform the surgeries that are absolutely needed and hold off on the elective surgeries.”

As second step, “exercise prudent formulary management and enforcement to assure that you are not engaging in over- or misutilization of drugs that might be regarded as ‘unnecessary,’ such as antibiotic usage in routine colonoscopy procedures,” Sones says.

To that end, educate your staff, Hovasse says. “Your director of nursing and clinical managers need to be aware of the shortage or the possible shortage, so we use the product most efficiently, to the best of our abilities.”

Current Shortage

To fight the current shortage, Hovasses’ ASC is trying to place as many orders as possible with as many vendors as possible. “We are looking at different units of measures and looking at alternate products, such as Normosol for lactated ringers,” she says. “We are also using alternative vendors such as Viaflow, manufactured in Spain, instead of B. Braun or Hospira.”

One of the medical supplies that Hurricane Maria disrupted the production of is smaller-volume bags of IV solutions.

“Everybody needs IV solutions,” Vortherms says. “We have been facing IV shortage for the last 3–4 years, but I have not seen a shortage this bad in my 35 years of materials management. Some ASCs might have to shut down for a couple of weeks to get caught up with the IV solution shortage.”

To buy IV solutions through wholesalers, Sones advises investigating direct ordering through the manufacturers. “Have those orders in play as you seed your orders with your wholesalers,” he says. “Reality is that hospitals might be ‘bumped’ to the top of the distribution list by wholesalers, so multi-wholesaler relationships that are nurtured in the course of the periods where shortages are not problematic might, similarly, be fruitful.”

The good news is that the manufacturer of IV solutions that got hit by Hurricane Maria, Baxter International, recently got permission from the FDA to import them from its offices in Australia and Ireland.

The other way the government could help with the saline shortage is to not let B. Braun shut down its California plant for three weeks in December for “critical maintenance work,” Vortherms says. “Customers are already experiencing back orders and B. Braun’s letter to its customers states, ‘ … we anticipate that this situation will continue through the first quarter of 2018.’ The government needs to step in and do something to stop worsening the saline shortage further with this plant shut-down.”