"We use a checklist of all the pieces that have to be put in place when you make a change," said Lynn Eschenbacher, Pharm.D., MBA, the pharmacy's clinical manager.
"We look at the data, determine how much drug we need, how much we have on hand, what the therapeutic alternatives are, and what our options are."
The process is driven by a committee that includes WakeMed's product buyer, business manager, operations manager, pharmacy director, medication safety officer, and Eschenbacher
"We meet to decide when to take a shortage to our P&T
committee to get approval for a formulary change," she
The plan also accounts for technical changes that must be put in place, such as adding new products to the pharmacy order system or rotating items from automated dispensing cabinets on the patient care units back into the pharmacy, Eschenbacher
The Problem With Third Parties
Coping with shortages is a time-consuming, labor-intensive task, according to Eschenbacher
"On any given day, I can spend two to four hours working on a shortage," she
"You have to figure out what the restrictions are for therapeutic substitution and decide if and when to go to a third party, such as a compounding pharmacy."
Buying from third parties is an expensive option.
For example, during a shortage of prefilled syringes of epinephrine, WakeMed
chose to contract with compounding pharmacies even though the system would not be reimbursed for the markup.
"We felt that safety outweighed the cost," Eschenbacher
"The alternative would be mixing and pulling up a syringe in a crisis.