The operational impact of medicines shortages on pharmacy Procurement and Distribution (P&D) services at a large teaching hospital
Authors: Salawu M , Considine A , Kelleher R , Hosny R , Razouk R , Uppal Z , Hansa Z , Badat H , Kelleher R , Hosny R , Razouk R , Uppal Z , Hansa Z 
Published: November 2024

Abstract

Introduction
There has been a nine-fold increase in medicines shortages in the UK over the last 5 years.1 The reasons are multifactorial including shortages in raw materials, as well as financial and geopolitical instability. The adverse impact on clinicians and patients is well documented however studies on the impact to P&D services is sparse.

Aim
This study aims to quantify the impact of increasing medicines shortages to P&D services who lead on sourcing and distributing alternative medicines to meet patient needs.1

Method
The period between January 2021 and January 2024 of the Pharmacy “Drug Shortages Tracker” was reviewed by the P&D Specialist Pharmacist. Each Shortage was assigned at least one of eight potential managing solutions e.g. “Rationalising Usage” and “Sourcing Unlicensed Alternatives”. The time required to complete the tasks for each shortage was calculated using the following formula:
[Sum of the Estimated Time to Complete Each Task* (minutes) x Duration of Shortage (weeks)] + Sum of the Estimated Time to Complete all ‘One Time Only’ Activities’*
* Standardised times based on time in motion data [collected in June 2023] and feedback from specialist P&D staff.
The data was recorded on a Microsoft Excel spreadsheet which had the following headings: Shortage, Method(s) of Resolution, Duration of Shortage and Total Time to Resolve.
This study was deemed a service evaluation by the trust’s Research and Audit Group and therefore ethics approval was not required.

Results
All 332 shortages are included in the results totalling 1,841 hours of staff time. The year by year breakdown is as follows: From 2021 to 2022, 3 shortages accounting for 49 hours. From 2022 to 2023, an increase to 146 shortages accounting for 898 hours (18-fold increase from previous year). From 2023 to 2024, 183 shortages accounting for 894 hours.
The number of shortages recorded per month was 0.24 from 2021 to 2022, 11.2 from 2022 to 2023 and 14 from 2023 to 2024.
The mean time required to complete the P&D aspects of a single shortage was 332 minutes. With the most time consuming shortage requiring 1640 minutes in 2022.

Discussion
This increased volume of shortages nationally has put pressure on P&D services to allocate greater resources to support their management and maintain patient safety.
P&D teams are assessed nationally on metrics relating to medicine expenditure.2 In practice, the core services that ensure medicines are available for patients’ takes precedent. The rising challenge of shortages poses a risk to the capacity of P&D teams to carry out both critical tasks and those relating to medicines expenditure.
Notable limitations to this study include the numerous interpretations and definitions of shortages which produced inconsistent recordings within the trust3. This was exacerbated by changes to documentation procedures internally. As an example, the variable recording process in 2021 does not provide an accurate representation of the actual period. Other internal changes included the uptake of automated dispensing cabinets which added further complexity to shortage management.

Conclusion
The growing demands of shortages highlights the need for dedicated shortages teams.

References
1. Connelly, D. (2023) ‘Special report: The UK’s medicines shortage crisis’, Pharmaceutical Journal [Preprint]. doi:10.1211/pj.2023.1.189330.
2. Specialist Pharmacy Service (2021) Pricing and Contract Coverage, NHS choices. Available at: https://www.sps.nhs.uk/articles/pricing-and-contract-coverage/ (Accessed: 01 June 2024).
3. Postma, D.J. et al. (2023) ‘Medicine shortages: Impact behind numbers’, Journal of Pharmaceutical Policy and Practice, 16(1). doi:10.1186/s40545-023-00548-x.