Last month, Talyst hosted a user group meeting in Chicago and the issue of drug shortages was a hot topic of discussion. I believe there are many contributing factors to the drug shortages and that inventory management practices can go a long way to help, but this complicated issue includes not only logistical issues but also ethical questions.
In a recent article in HealthLeaders Media, “Drugs Shortages: 10 Ethics Rules for Hospitals,” it states that hospitals must have rules and be accountable when administering limited medication supplies to patients. Drug shortages are a nation-wide issue and many health systems are still struggling to keep specific medications on-hand.
According to clinicians at Duke University Medical Center, an ethical defensible drug rationing plan can help healthcare providers make fair and equitable choices.
“This plan obeys a simple, straightforward set of rules for fairness and allocation that was vetted by a large number of people—physicians, nurses, social workers, ethicists as well as community members and patient representatives,” says Philip Rosoff, MD, Duke’s director of clinical ethics and the principal investigator of the Duke project.
The Duke University Medical Center uses the “10 accountability for reasonableness” steps that are outlined in the Archives of Internal Medicine. Key steps include allocation of drugs must be fair with no special treatment, and choice must be relevant to the population of patients and healthcare providers.
It is not easy to make the choice of who receives a limited medication. Often shortages can be helped by having a perpetual inventory with alerts, ensuring the central pharmacy is immediately aware when specific medications run low. Having a perpetual inventory with alerts allows pharmacists to prepare for alternative treatments and methods for certain conditions.
How does your health system handle drug shortages? Do you have rules of ethics to ensure fair choices are made at your hospital?