Drug shortages pose patient safety risks, increased hospital costs

Drug shortages continue to challenge providers to properly care for patients while increasing America's health care costs, according to an updated Premier, Inc.

Among survey respondents, approximately 90 percent experienced at least one shortage in the last six months that may have caused a medication safety issue or error in patient care. This is comparable to results from a similar survey Premier conducted at the height of the drug shortage crisis in 2010. The current survey of 124 pharmacy experts, conducted over a five-week period in December 2013 and January 2014, provides a fresh look at the prevalence of drug shortages.

"Although recent reports show that new drug shortages have decreased, longer-standing, ongoing drug shortages remain an issue," said Michael J. Alkire, Premier chief operating officer. "The supply chain is also vulnerable to shortage 'spikes' that significantly disrupt patient care and hospital operations. To remedy these types of shortages, including one currently affecting the supply of intravenous solutions, we need a 'swat team' mentality by all, including the FDA, the manufacturers, the distribution channel, the GPOs and the hospitals. FDA in particular plays a critical role given their role in approving the availability of additional drug supplies."

An additional Premier analysis shows U.S. hospitals that were forced to purchase more expensive generic substitutes for shortage drugs incurred additional costs averaging about $229.7 million annually from 2011 to 2013. The total economic impact is likely much higher since the figure excludes drugs purchased from off-contract distributors, more expensive purchases of therapeutic alternatives and indirect costs such as added labor.

According to the survey, the most often cited shortage drugs affecting patient safety and costs were:  

  • Electrolytes, intravenous fluids and parenteral nutrition solutions, which provide patients unable to take oral fluids or food with needed hydration and nutrition intravenously
  • Cardiovascular agents used to treat heart disease and other cardiac conditions
  • Surgical agents used for surgery preparation/anesthesia and sedation

However, the prevalence of shortages affecting patient care appears tobe decreasing. Compared with 2010, respondents enduring fewer shortages (one to five) increased by 30 percent during this period, while those experiencing six or more occurrences decreased 26 percent. In addition, 35 percent of respondents did not experience a shortage that could have delayed or cancelled care, a two-fold improvement from 2010 results. Respondents enduring six or more occurrences decreased 46 percent from 2010.

Survey results also indicate providers have become more skilled at handling supply chain disruptions since 2010, implementing more effective programs to cope with ongoing shortages, including:

  • 90 percent added back-up inventory or adjusted par levels for critically important drug categories
  • 87 percent increased communications about shortages to internal stakeholders
  • 83 percent implemented restrictions and/or rationing for short supply drugs.

Mother's voice improves hospitalization and feeding in preemies

Premature babies who receive an interventional therapy combining their mother's voice and a pacifier-activated music player learn to eat more efficiently and have their feeding tubes removed sooner than other preemies, according to a Monroe Carell Jr. Children's Hospital at Vanderbilt study published today in Pediatrics.

The randomized clinical trial performed in the neonatal intensive care unit at Children's Hospital tested 94 premature babies, pairing their mother's voice singing a lullaby with a pacifier activated music player.

To qualify for the study the babies had to have reached 34-36 weeks postmenstrual age, be in stable condition and able to breathe on their own. The participating babies received the intervention for 15 minutes a day for five days in a row. When they sucked correctly on their pacifier, a special device with sensors and speakers, they were rewarded by hearing their mother singing a lullaby. If they stopped sucking, the music would stop.

"A mother's voice is a powerful auditory cue," said study author Nathalie Maitre, M.D., assistant professor of pediatrics. "Babies know and love their mother's voice. It has proven to be the perfect incentive to help motivate these babies."

Music therapist Olena Chorna worked closely with the mothers, making them comfortable and teaching them the two study-approved lullabies, "Hush Little Baby" and "Snuggle Puppy." The lullabies selected were chosen with care. The melodies had to be simple, repetitive and within one octave range. Anything more complex could be too much for a premature baby's developing brain. The songs were then recorded and connected to the pacifier-activated music player.

Maitre and Chorna analyzed the data with the help of James C. Slaughter, assistant professor of biostatistics. The study shows babies who receive the pacifier intervention were able to have their feeding tubes removed about a week earlier than babies who did not receive the intervention. In addition, the results show clear evidence babies ate more frequently and developed a stronger sucking ability, and did not show signs of stress during their pacifier sessions. They also appeared to have shorter hospitalizations.

"The benefits are both medical and emotional as this is a unique way for parents to directly help their children learn a skill crucial to their growth and development," Maitre said. "It gives parents a small amount of control to improve their baby's medical course, in addition to giving them a bonding experience which will last throughout childhood."