Managing medicines: Shortages of medicines
- Harm – by missing doses when a drug isn't available, a patient may be forced into non-compliance and a chronic condition could deteriorate as a result.
- Inconvenience – if they run out, patients may have to return to their doctor/pharmacist to get advice on how to manage the situation and/or to be prescribed an alternative drug.
- Uncertainty – insufficient supplies of a medicine, or being prescribed an alternative, may confuse the patient or cause anxiety about long-term management of a medical condition.
- Dissatisfaction – understandably, patients may be dissatisfied if they can’t obtain a medicine they need.
Reasons for shortages
There are many potential reasons for unavailability or shortages of medicines. Some happen for local reasons, while others are wider in scale. They include:1. Potential local reasons
- Patient is taking a medicine that isn't on your hospital's formulary and it needs to be ordered in.
- Stock management issues (e.g. stock ordering levels are wrong; rarely used medicines have expired by the time they’re needed).
- Predictable increased local usage, but the Pharmacy Stores have not been informed (e.g. a change in policy towards use of a medicine).
2. Non-local reasons
- Regulatory delays (e.g. the latest batch of a medicine fails quality assurance, drug recall, new manufacturing standards lead to a manufacturing delay while they are implemented).
- Product discontinued by manufacturer.
- Manufacturing failure (e.g. catastrophe at factory; raw materials shortage).
- Increased demand (e.g. evidence-based change in practice, or sudden change to use of an infrequently used product due to shortage of the first-line choice).
- Changes in pricing and drug reimbursement arrangements for medicines
- Wider geopolitical reasons
Managing shortages
A patient may be worried if their medicine is not available so it’s important to explain why a shortage has occurred, and how long it may last. If a shortage might mean switching to an alternative product, then what will this mean for the patient? A different method of administration, potentially new side effects, additional monitoring?For medium to long-term shortages, pharmacists need to explain the situation to their community of prescribers, then help to identify suitable alternatives and advise on how best to prescribe them safely. If you encounter a shortage of this kind, your Trust may already have a memo or policy about which alternative(s) you are to use.
• The Department of Health and Social Care (DHSC) and NHS England (NHSE) have published a Guide to Managing Medicines Supply and Shortages to support pharmacists, clinicians and other NHS professionals with reporting medicines supply issues and actions to take when a shortage arises.
• A Medicines Supply Tool is provided by DHSC and NHSE Medicines Supply Team on the Specialist Pharmacy Service website. This has the latest information on supply issues, actions to take, alternatives to use and expected resolution dates. You need to register with your NHS email address to use the tool.
• For shortages that have the potential for more serious patient safety or system wide impact, the DHSC uses the NHS Central Alerting System to issue a ‘National Patient Safety Alert’.
• For general guidance on managing medicines shortages in secondary care, refer to the Royal Pharmaceutical Society's Best Practice Standards for England.
• A House of Commons Research Briefing on Medicines shortages provides more information on the causes and consequences of shortages in the UK and internationally.
We've devised some questions to ask to help you manage an individual inpatient, starting on the next page.
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