Community rheumatology practices are finding it increasingly difficult to source vital therapies and supplies to care for patients.
While the COVID-19 pandemic compounded supply chain issues and caused disruptions that impacted every industry, healthcare has been among the hardest-hit. Exacerbated further by drug, fluid and supply shortages, community rheumatology practices are finding it increasingly difficult to source vital therapies and supplies to care for patients, especially as drugs indicated to treat lupus and rheumatoid arthritis received approval to treat COVID-19.
In fact, the American College of Rheumatology (ACR) expressed concern last Fall about shortages of tocilizumab after its usage was okayed for COVID-19 treatments by the FDA, with demand for the drug increasing by more than 400% beyond pre-Covid levels in just two weeks.
But, even beyond drug shortages, the scarcity of materials that seemingly do not connect to healthcare can also end up impacting patients. For example, aluminum shortages can mean the glass drug vials that use aluminum caps are now unavailable. The decrease of the production of plastic resins following a winter snowstorm in the South, not only slowed, but also drove prices up 30% to 50%, have also hurt practices because the resin is necessary to produce polyethylene IV bags.
With all of these dynamics in mind, below are four ways to help you navigate supply disruptions:
It may seem simple to say you should always know what you have in stock, but especially in times of supply chain slow-downs, it is vital to review your inventory regularly. Your practice must know the daily, weekly or monthly usage, so you know around how long each drug should last.
If your budget allows, maintain a “safety stock.” This will vary by practice, but ideally, keep an average one-day usage for the top 20 drugs used at your practice. Review this with your practice owners, the accounting team and clinical leadership to determine the best balance between cash flow vs “cushion.” Also be sure to keep single-source generics and drugs without alternatives in stock because during a shortage, these products will not be available from other manufacturers.
Connections. Connections. Connections. We recommend getting to know your account managers at suppliers and distributors. It’s their job to monitor for potential disruptions, and they often have a more holistic view, so they can give you a heads up about shortages, help you navigate allocations, and be a quick point of contact for questions.
Something that is becoming more common across the industry is initiating a “supply buddy” relationship which another practice, hospital, or health system in your area. Buddies can help you in times of need and vice versa. If one of you is running low on something, the other can contribute to ensure patients are getting the best care despite what may be happening elsewhere in the world.
Lastly, talk with your peers at other practices to see where they are getting supplies that are hard to find. Ask your employees to reach out to their networks to find alternative products if needed.
Not all supply shortages are unexpected. For instance, you may expect, or plan for, a shortage following a natural disaster or period of conflict. As mentioned in the beginning of this article, the plastic resin supply issue is due to a winter storm that stopped production. Factories and warehouses can be shut down or destroyed, and roads and delivery ports can be closed, stopping delivery trucks or ships from getting through. It’s important to watch for general supply chain issues on the news, which may help you foresee a shortage.
Another instance when you can predict a future shortage is if one manufacturer of a multisource product discontinues or stalls production and other manufacturers have to ramp up production – they may not be able to fill the gap. One pertinent example is Pfizer concentrating efforts in COVID-19 vaccine production. Only a few other companies manufacture saline, and there was no way for them to increase production fast enough to make up for Pfizer’s retraction from the saline market over the last year.
Additionally, keep an eye on your email for communications from manufacturers and distributors about shortages or allocations, and act swiftly if you need to order. You can also use resources like the Food and Drug Administration (FDA) website or app to track industry shortages.
One of the most valuable things you can do to prepare for shortages is ensuring your staff knows about possible substitutions. It is not always safe to substitute one fluid for a similar one, or to take large bags of fluids and break them down to smaller containers. Some drugs that are compatible in NaCl may not be soluble in D5w. Others may need reconstitution in preservative-free fluids to avoid adverse events.Without proper sterile compounding facilities, it can be easy to contaminate fluids that are transferred from manufactured sterile containers. This is a serious safety issue for patients, as well as a possible legal liability.
To help you navigate substitution, Cardinal Health and the National Organization of Rheumatology Management (NORM) created a reference guide that includes rheumatology and other infusion drugs that require dilution and/or reconstitution, alternative products that are already reconstituted or SubQ products that do not require dilution.
You can also talk with the manufacturer to learn more about additional drug indications. Most companies will be eager to provide data to support alternate ways to mix or administer their drugs in times of shortages. Use the information you obtain to develop protocols for substitution.
Lastly, empower your employees to respond rapidly to shortage issues. Create a plan as a practice by defining which circumstances need a quick response, map out a plan to review existing orders and identify inventory shortages, and identify who in the practice is in charge of keeping track of this information.
Tracking inventory, monitoring potential drug shortages, training staff, and paying attention to all communications can be an exhausting experience, but it will prepare your practice to navigate through a supply chain disruption.
*These are suggestions; please check your local rules and regulations for guidance.
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