title: Effects on patient care caused by drug shortages: a survey.
abstract: BACKGROUND
  Drug shortages pose a serious challenge for health care institutions, often interfering with patient care. A common practice during a drug shortage is to select an alternate therapeutic; however, these agents often present challenges and may create safety concerns. Patient harms including adverse events and medication errors may occur. Patients may also file complaints because of drug shortages.
  
  
  OBJECTIVE
  To measure the effect of drug shortages on patient outcomes, clinical pharmacy operations, patient complaints, and institutional cost.
  
  
  METHODS
  An e-mail link to an online survey was sent to pharmacy director members in the MedAssets Pharmacy Group Purchasing Organization. Data were collected within a 3-week period from October 2-23, 2012. The survey focused on 6 different domains: demographics, adverse events, medication errors, patient outcomes, patient complaints, and institutional cost.
  
  
  RESULTS
  The survey was sent to 1,516 directors of pharmacy. There were 193 respondents (response rate 13%) who participated in the survey. Approximately 40% of respondents reported between 1 and 5 adverse events probably or possibly associated with drug shortages at their institution. The majority of respondents reported between 1 and 10 medication errors. The most common types of medication errors reported were omission (n = 86, 55.5%), wrong dose dispensed/administered (n = 85, 54.8%), and wrong drug dispensed/administered (n = 54, 34.8%). The most common outcomes reported by respondents were alternative medication used (n=146, 85.3%), delay of therapy (n = 121, 70.8%), and increased patient monitoring necessary (n = 84, 49.1%). Patient complaints were reported by 38% of respondents. The majority of respondents reported an estimated quarterly institutional cost from shortages of less than $100,000, and approximately one quarter of respondents reported adding at least 1 full-time equivalent to manage drug shortages. The majority of participant comments mentioned the increasing institutional costs attributed to drug shortages.
  
  
  CONCLUSIONS
  Medication errors and adverse events continue to occur from drug shortages, often resulting in inadequate patient care, high institutional costs, and patient complaints. Delayed care and cancelled care have been reported from shortages. Further research is necessary to better classify medication errors and adverse events during a drug shortage.
authors.affiliation: Midwestern University Chicago College of Pharmacy, Department of Pharmacy Practice, 555 31st St., Downers Grove, IL, 60515, USA. milgriff@nmh.org.
authors.forename: Milena
authors.initials: M
authors.lastname: McLaughlin
authors.forename: Despina
authors.initials: D
authors.lastname: Kotis
authors.forename: Kenneth
authors.initials: K
authors.lastname: Thomson
authors.forename: Michael
authors.initials: M
authors.lastname: Harrison
authors.forename: Gary
authors.initials: G
authors.lastname: Fennessy
authors.forename: Michael
authors.initials: M
authors.lastname: Postelnick
authors.forename: Marc H
authors.initials: MH
authors.lastname: Scheetz
mesh_terms: D064420:Drug-Related Side Effects and Adverse Reactions / Q000175:diagnosis / Q000453:epidemiology; D006306:Health Surveys / Q000379:methods*; D006801:Humans; D008508:Medication Errors / Q000639:trends; D005791:Patient Care / Q000592:standards* / Q000639:trends; D004364:Pharmaceutical Preparations / Q000600:supply & distribution*; D010595:Pharmacists; D010607:Pharmacy Service, Hospital / Q000592:standards* / Q000639:trends; D016896:Treatment Outcome
chemical_list: D004364:Pharmaceutical Preparations