title: Impact of supply problems of preservative-free glaucoma medications on patients and hospital staff.
abstract: OBJECTIVE
  Glaucoma is a chronic ocular disease, which is usually managed with long-term daily medical therapy, in the form of eye drops. Patients who are intolerant to preservatives in topical medicines require preservative-free versions. From early 2011 patients attending Moorfields Eye Hospital, London, UK, started to report recurring problems with the supply of the following preservative-free glaucoma medications: Timolol 0.25% (Timoptol 0.25%, MSD UK); Dorzolamide (Trusopt, MSD UK); Dorzolamide and Timolol 0.5% (Cosopt, MSD UK). This study investigates the impact of the supply problems of these medications at Moorfields Eye Hospital from a patient, administrative and clinical perspective.
  
  
  METHODS
  Information was sought by interviewing both patients and hospital staff, and by a retrospective case note review between April 2010 and May 2013.
  
  
  RESULTS
  Many hospital roles, both administrative and clinical, were involved in attempting to resolve the impact of the supply problems. All staff reported a considerable increase in their workload. At the peak of the problem, the glaucoma secretaries received about 150 enquiries per week. A review of 83 sets of patient notes, retrieved from a random sample of 125 patients, showed that 22% encountered a supply problem. Of these, more than one-third attended Moorfields Eye Hospital Accident & Emergency (A&E) for repeat supplies and 89% eventually had their medication changed. In telephone interviews with 39 of a random sample of 50 patients (a subset of the 83 notes retrieved), 59% of the interviewees reported a supply problem. Of these, one-third attended Moorfields Eye Hospital A&E for repeat supplies and half eventually required an alternative medication. Some patients reported going to considerable lengths to obtain ongoing supplies in the community.
  
  
  CONCLUSIONS
  This study shows that medication supply problems can have a major impact on patients and hospital services. Supply problems occur across many fields of medicine and with increasing frequency. The findings of this study highlight the importance of early communication of impending shortages between manufacturers and the Department of Health, as recommended in the best practice guidelines. In order to minimise the impact of medicine shortages on patients, clinicians and administrative staff, hospitals need immediate notification of potential supply problems and clear updates on supply resolution. In addition, hospitals should consider nominating an individual as a contact point for patient enquiries regarding medicine supply problems.
authors.affiliation: Moorfields Eye Hospital, London, UK.
authors.forename: Shima
authors.initials: S
authors.lastname: Shah
authors.forename: Julia
authors.initials: J
authors.lastname: Theodossiades
authors.forename: Kristin
authors.initials: K
authors.lastname: Chapman
authors.forename: Ian
authors.initials: I
authors.lastname: Murdoch
mesh_terms: D000328:Adult; D000368:Aged; D000959:Antihypertensive Agents / Q000600:supply & distribution*; D001291:Attitude of Health Personnel; D057915:Drug Substitution; D005260:Female; D005901:Glaucoma / Q000188:drug therapy*; D006801:Humans; D008875:Middle Aged; D017060:Patient Satisfaction; D012189:Retrospective Studies; D013315:Stress, Psychological / Q000209:etiology; D011795:Surveys and Questionnaires; D016526:Workload
chemical_list: D000959:Antihypertensive Agents
keywords: dorzolamide; drug supply; eye; glaucoma; medicines supply; preservative-free drops; timolol