Introduction
One of the major healthcare delivery issues that has impacted patients on ethical grounds is the rapid shortage of medications. Shortage of drugs has also impacted healthcare professionals and the healthcare system owing to regulatory issues, raw material disputes, and manufacturing problems (Ventola, 2011). The shortage of drugs has led to the substitution of safe and effective drugs with alternate, compromised, and ineffective treatments. The burden of shortage has a direct impact on medication errors, healthcare professionals, and finances of healthcare facilities (Ventola, 2011). Drug shortages comprise the overall quality of care and significantly impact the healthcare system. In order to improvise the shortage of drugs, effective decision-making, information gathering, communication plans, and procedures should be implemented within the system (Ventola, 2011).
Ethical Principles
The shortage of drugs is addressed by two key ethical principles, ‘The principle of behavioural economics’ wherein the economics and psychology of varying factors that are related to the shortage of drugs are addressed. The other ethical principle that is addressed is ‘The principles of beneficence, non-maleficence, and justice’ (Weaver, 2010).
Drug shortage crisis in the US
The drug shortage crisis in the US has reached an alarming rate and based on the ASHP/UUHC drug shortage program, manufacturing accounts for 23% of the problem followed by supply/demand issues at 13% and other issues. Researchers and healthcare professionals are unable to identify a major portion (55%) of segment through which drug shortages occur in the US. Drug shortages are a critical issue and this paper provides and overview on the issue with respect to causes, impact on nursing and patients, principles addressed, and strategies to resolve the issue (Fox, Sweet, & Jensen. 2014).
Issues of drug shortages: The risk and causal factors
Manufacturing Difficulties: Key factors include shift of company resources, antiquated equipment, loss of production, compliance issues and other problems linked with staff. Product availability is also hampered by change in formulation of the product. Shortages of Raw Materials: The supply of bulk and raw materials are known to increase drug shortages. A major impact is observed when only one source supplier of a raw material is affected which creates problems to multiple manufacturers. Voluntary Recalls: Drug recall from a sole manufacturer has a major impact on drug production. Safety issues and compliance irregularities are often major risk factors that are related to drug recalls and major reasons for drug shortages. Natural Disasters: Natural disasters affect drug product availability. Floods, fires, cyclones, and tornados have an impact on manufacturing facilities. Supply and Demand Issues: In cases of epidemics or life-saving drugs, the demand may increase significantly which would indirectly relate to drug shortage. Many unpredictable factors and change in therapeutic guidelines impact supply and demand (Ventola,. 2011).
Issues and impact on nursing profession and patients
Medication Errors: Healthcare professionals and nursing staff are forced to prescribe alternative and ineffective drugs to patients in the event of drug shortages which increases the rate of medication errors. Most important factors that cause errors are dose adjustments, drug concentrations, product forms, and unknown risks. Nurses also risk their career by providing drugs that could cause over or under dosing and provide risk to patients (Carter. 2011).
Safety Risks: The substitution of an alternate drug can lead to various safety risks such as reduced efficacy and unpredictable or unknown side-effects. The potential risk associated with alternate drugs during shortages include delayed treatments, inadequate treatments, adverse events, and even death (Lipworth, & Kerridge, 2013).
Compromised Clinical Outcomes: Most nurses would observe a loss of rationale for most treatments, cancellation of interventions, and the use of medications with known or unknown safety profile. In most cases, nurses are forced to provide expensive drugs that have unknown safety data, dosing regimens, and protocols which leads to compromised clinical outcomes.
Importance of drug shortage in the nursing profession
Nurses are the backbone of the healthcare system. In the event of a drug shortage, nurses are forced to opt for alternative treatments that are out of their will and may also put their skills, knowledge, and calibre to stake. Most nurses are bound to legal proceedings if life-threatening adverse events or death occur in a patient administered with an alternate treatment. There are no defined regulations and policies to safeguard the rights of a nurse in the event of shortage of drug and use/prescription of alternates for patients. Nurses are also bound to make medication errors and clinical mistakes in such scenarios. Nurses often suffer from burnout during drug shortages (Gulbis, Ruiz, & Denktas. 2013).
Resolving the issue of drug shortages
Validate Drug Shortages: The best method to resolve drug shortages is to address the back order and health system’s drug-purchasing personnel prior to stock depletion. The situation can be kept under control if the supply chain system is informed on the potential shortage. Follow Good Inventory-Management Practices: Inventory managers should follow best industry practices and predicting shortages and stockpile drugs since this could create an unreasonable in demand of drugs, thus increasing drug shortage even more. Efficient Communication strategies: The inventory manager and supply chain personnel should inform the healthcare facility on the probable shortage of the drug and other communication strategies (Gagnon. 2012). Thus, drug shortages are a common problem in the US but can be tacked by efficient and effective strategies.
References
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