“Continuity plans are often focused on dealing with a major incident, and in hospital pharmacy  – aside from power cuts and IT failures – are often geared towards supplying urgently needed medicines for large numbers critically injured patients presenting to secondary care following such a major incident. The challenge with COVID-19 has been managing this supply of medicines when both pharmacy staff and the medicines themselves have been in short supply.

Medicine shortages are nothing new, but it feels increasingly like the supply chains are fragile, and at a time of unprecedented demand. This article by Andrew Hill, published in the Pharmaceutical Journal, comprehensively outlines the problems with medicines supply chains in the UK, including concerns about critical medicines such as diamorphine, and in Europe the problem is similar. In 2019, the European Association of Hospital Pharmacists published the results of its most recent medicines shortages survey, based on results from over 2000 hospital pharmacists in 39 countries (2). Of the medicines noted to be in short supply by hospital pharmacists, antimicrobial agents and anaesthetic agents were first and third most commonly reported, respectively. Small wonder then, that critical care pharmacy teams have been busy liaising with fellow critical care staff and pharmacy procurement teams when planning for the anticipated surge in critical care admissions due to COVID-19.

Medicines shortages can have a negative impact on patient care, and are often time consuming and costly to deal with. The workload for the pharmacy department can be significant, but invisible to the rest of the hospital  – perhaps borne out by the finding in the EAHP survey that 95% of pharmacists felt medicines shortages to be a major problem, but only 72% of physicians and 69% of nurses. Sourcing alternative agents, amending guidelines/protocols and stock lists, communicating changes to a diverse workforce and dealing with issues out of hours can amount to a significant amount of time spent resolving problems, at a time when the service might be stretched due to the pandemic and staff shortages. Non-specialist procurement staff might have to be drafted in to fill the gaps; there may be delays in obtaining medication due to using different suppliers, translations of patient information leaflets and data sheets might need to be obtained; risk assessments of medications which are supplied in strengths different to the norm, or are prepared differently; and quality control checks of unlicensed medicines are required before they can be issued to clinical areas.

The pandemic has shown us that supply chains are everything – whether that be medicines for critical care, personal protective equipment, or just toilet roll.”

Dr Conor Jamieson, Pharmacy Team Leader – Antimicrobial Therapy, Sandwell and West Birmingham NHS Trust

@jamiesonce