Purpose for the Program
The 2011 American Hospital Association survey found 100% of responding hospitals (N = 800) experienced a drug shortage in the past 6 months. The proposed presentation will present a model of care developed in response to a critical shortage of injectable vitamin K to newborns at a tertiary regional hospital. The implemented management strategy, developed by a transdisciplinary team, considered issues of safety, ethics, communication, collaboration, education, and evaluated published, evidence-based data on the use of alternative formulations of vitamin K.
In an immediate response to a critical injectable vitamin K shortage at a children's hospital, a transdisciplinary team was formed and an action plan developed, which currently serves as a response model for drug shortage management. Inclusion of the voice of patients was a cornerstone to addressing their needs during this drug shortage crisis.
Implementation, Outcomes, and Evaluation
The response included availability assessment of alternative drug formulations; development of evidence-based clinical guidelines; electronic point of care decision-making tools for physicians; education materials for patients/families; education materials for healthcare providers on management plans; ethical considerations for rationing of supplies; and communication strategies for all administrators, healthcare providers, and patients. The success of the program was linked to working with a local pharmacy to compound oral vitamin K for administration to the infants who met the criteria for that route of administration. Injectable vitamin K was reserved for infants in the neonatal intensive care unit and high-risk infants.
Tools developed to support the model of drug shortage response include color coding system of drug supply for pharmacy and healthcare providers, process flow diagrams, published literature classification system, point of care decision templates, lists of ethical principles to consider, pharmacy policies guiding evaluation of alternative suppliers, and educational guides. As a result of the collaborative response to the injectable vitamin K shortage, 100% of the infants, whose parents consented to receive vitamin K, were given the correct oral dosage while in the hospital. Continued development and system-wide dissemination of the drug shortage response model is underway.
Implications for Nursing Practice
By proactively addressing the drug shortage, safety, evidence-based clinical practice, ethical decision making, efficiency, and cost have the potential to be affected. The response to drug shortages is best conducted with a proactive, rather than reactive, approach to have the necessary elements in place for an appropriate controlled response.