Since the pandemic, healthcare supply chain shortages have worsened significantly, and many health systems are scrambling to find substitute products to avoid disrupting or delaying necessary patient care, Alex Kacik writes for Modern Healthcare.

Supply chain shortages are getting worse

According to data from the  American Society of Health-System Pharmacists, there were 301 active drug shortages in the United States at the end of the first quarter of 2023, the highest level since 2014. Separately, a recent report from the Senate Committee on Homeland Security and Governmental Affairs found that drug shortages increased by almost 30% between 2021 and 2022.

"Shortages continue to have devastating consequences for patients and health care providers, including medication errors and treatment delays, and in some cases, have led to doctors having to ration lifesaving treatments," the report said.

In addition to drugs shortages, many organizations are also facing critical shortages of other medical devices and supplies, including ligatures and oxygenators to stop bleeding, catheters for heart surgery and urology, and custom procedure trays and surgical packs.

According to health system administrators, the range and severity of supply shortages have worsened since the COVID-19 pandemic, and these shortages are expected to continue even beyond the end of the public health emergency.

At  Scripps Health, the number of products on backorder tripled in 2020 before increasing to five-fold in 2021. Although the organization was "hoping to see some light at the end of the tunnel in 2022, […] we are now at an eight-fold increased compared with 2019," said Joshua Spangler, Scripps' associate VP of supply chain procurement, strategic sourcing, and accounts payable.

"This is by far the worst supply chain disruption I have ever experienced," said Spangler, who has worked in healthcare supply chain roles for over 25 years.

A lack of transparency between manufacturers and providers is also likely exacerbating these current shortages. According to the recent Senate report, over 90% of generic sterile injectable drugs for critical care contain ingredients from China and India, but manufacturers are not required to disclose information about which products they manufacture overseas.

How these shortages are impacting hospitals

As shortages worsen, supply chain managers at hospitals have to more frequently use lower-tier options on their list of substitute products, which often require a new workflow or training. And with clinicians spending more time adjusting to these changes and less familiar products, there is an increased likelihood of mistakes occurring.

"The secondary and tertiary substitutes are frequently unavailable and providers have to change protocol," said Mittal Sutaria, SVP of pharmacy contracting and program services at  Vizient. "When you have to use a product you are not as familiar with or one that is suboptimal, that can increase the chance of errors or negative outcomes."

For example, Sanford Health, among other health systems, has struggled with a shortage of liquid albuterol, which is used to treat asthma and patients on ventilators, in recent months. In February, Akorn Pharmaceuticals, which was the only domestic manufacturer for a large dose of albuterol, stopped production and shut down its U.S. operations.

With supply of the larger dose no longer available, Nate Leedahl, who manages Sanford's pharmacy operations, said clinicians have had to administer doses more frequently from the smaller albuterol sizes.

"It requires more communication, more space to store smaller vials and an appreciable amount of astuteness from bedside practitioners," Leedahl said. "More manufacturers are bowing out of the market perhaps because the cost of making the supply outweighs the return on investment."

Although health systems have not yet had to delay or cancel procedures due to these supply shortages, providers are asking for manufacturers to have more robust reporting requirements and for them to increase production of vital, commonly used drugs and devices to prevent any care disruptions.

"Prompt reporting can help hospitals know to institute rationing plans, but reporting alone can't improve supply [levels]," said Erin Fox, senior pharmacy director at  University of Utah Health. (Kacik, Modern Healthcare, 4/17)