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Shortages of prescription drugs have been a growing concern both nationally and locally.

The number of drugs on shortage has increased from 58 in 2004 to a record 267 in 2011. Last year, nearly half of hospitals reported experiencing a drug shortage on a daily basis, according to a survey of 820 hospitals by the American Hospital Association. Shortfalls are so common, pharmacy staffers at hospitals spend many extra hours to ensure there’s an uninterrupted flow of medicine to patients.

In Missoula, the majority of drug shortages are generic medications given intravenously to relieve pain, fight cancer or infections, anesthetize surgical patients or treat cardiovascular disease. While the scarcity of drugs has caused some issues, we are not aware of any errors or other harm to patients caused by these shortages.

The reasons for the drug shortages are complex, but appear to be most often the result of manufacturing issues. Reasons include stopping or temporarily stopping production of a drug due to quality problems with how the drugs are made, stopping production of drugs due to shortages of raw materials, companies making business decisions to stop making a product, or changing the amount of medications supplied to different hospitals and pharmacies.

Hospitals rarely get advance notice of shortages, explanations of what caused them or estimates of how long they will last. Hospital pharmacies are then forced to find substitutes, which often can be more expensive, may require repackaging higher concentrations into smaller doses,and sometimes may require rationing drugs.

Pharmacy buyers often are the first to hear about shortages. This begins a process in which the buyer tries to calculate how long a shortage might last, and the hospital tries to buy protectively. Hospitals resort to mixing drugs for their own use, which maximizes supplies and minimizes the chances of error.

Pharmacists have become more aggressive when dealing with drug shortages, addressing the issue on a daily basis. If there is a new shortage of a drug, we quickly calculate which areas of the hospital use the drug, how much they use and how long the existing stock will last. We then notify doctors and nurses of the current issues. Dealing with drug shortages is time-consuming, involving multiple people. The goal is to make sure that when patients come to the hospital, their care is seamless.

Health care organizations are working with Congress, drug manufacturers and the Food and Drug Administration to prevent or reduce drug shortages. In late October 2011, President Barack Obama signed an executive order directing the FDA to speed up reviews of new manufacturing facilities and to make manufacturers report shortages earlier.

While the reasons for drug shortages are complex with no easy fix, your caregivers are making every effort to ensure your care is not changed. If you have more questions, talk to your pharmacist or doctor.

Danielle Sebastian is the pharmacy clinical manager at St. Patrick Hospital.

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