Scripps Health has about eight times more medical equipment and supplies ordered than the integrated nonprofit health system had in 2019.
San Diego, California-based Scripps has been managing ligament shortages and hemostatic oxygen generators, catheters used in cardiac and urological surgery, custom procedure trays and surgical packages, and different things.
While suppliers, distributors and manufacturers have grappled with supply chain disruptions for critical equipment, supplies and pharmaceuticals for years, health system managers say know this latest round more difficult. Supply chain managers must frequently use the fourth, fifth, or sixth option on their list of substitutes, requiring a new workflow for nurses and doctors.
“This is by far the worst supply chain disruption I have experienced,” said Joshua Spangler, vice president of supply chain procurement, strategic sourcing and accounts payable at Scripps , who has worked in a healthcare supply chain role for about 26 years.
As health systems move further on their list of preferred substitutes, clinicians will spend more time making adjustments, increasing the potential for error as they work with products. less familiar products.
“Tier second and third tier substitutes are often unavailable and vendors have to,” said Mittal Sutaria, senior vice president of pharmaceutical contracts and program services at group purchasing organization Vizient. process change. “When you have to use a product you are not familiar with or a product that is suboptimal, that can increase the likelihood of errors or negative outcomes.”
Health system administrators say the scope and severity of shortages has worsened since the COVID-19 pandemic, citing a lack of transparency between manufacturers and suppliers continue to make the system difficult. Supply chain shortages are expected to continue beyond the end of the public health emergency.
Spangler said pre-orders tripled between 2019 and 2020, largely related to personal protective equipment. The number of pre-ordered products has increased fivefold in 2021 from pre-pandemic levels due to urgent care supplies, plastics used in medical equipment circuits, ventilators, he said. and related supplies have been exhausted.
“We were hoping to see some light at the end of the tunnel in 2022, but we’ve now grown eight times that,” Spangler said.
The number of alternative suppliers, especially low-cost generics and medical supplies, continues to wane as drug and device manufacturers Prioritize more profitable products. Industry observers say that often leaves a source or two for items the hospital uses every day.
Sioux Falls, South Dakota-based Sanford Health is dealing with similar supply chain challenges. The number of items pre-ordered has tripled in recent months, from trash can liners to balloon pumps in the aorta, which help the heart pump more blood. Dr. Jeremy Caulwels, Sanford’s Chief Physician, said the nonprofit health system that manages a list of six to 16 replacement devices is sufficiently different from the preferred option that they require training or adjustment. working process.
He said: “It is remarkable how much is in short supply that you would never think you would run out of.
For example, eye drops have been in short supply for months. Akorn Pharmaceuticals stopped making eye drops used to treat glaucoma in early 2022, and other manufacturers have struggled to meet demand. Akorn, which did not respond to a request for comment, filed for Chapter 7 bankruptcy in February and is shutting down its U.S. operations after years of struggling with quality and financial issues.
Akorn also stopped making liquid albuterol in February, which is used to treat asthma and for patients on ventilators. It is the only local manufacturer with a large dose of albuterol and one of the two major global suppliers.
That means clinicians in Sanford have to use dosages more often because of just the smaller size, said Nate Leedahl, the health system’s pharmaceutical operations manager.
“It requires more communication, more space to store smaller vials, and considerable intelligence from bedside practitioners,” he said. “Many manufacturers are pulling out of the market perhaps because the cost of production supply outweighs the return on investment.”
Before the COVID-19 pandemic, Sanford supply chain managers could count on a piece of paper how many drugs were made by one or two manufacturers. “That list is growing,” Leedahl said.
According to data from the American Association of Health System Pharmacists, the number of drugs in shortage reached 301 at the end of the first quarter, the highest level since 2014. According to ASHP, chemotherapy drugs are often unavailable. Alternatives are increasingly scarce.
The prevalence of drug shortages prompted a March report from Senator Gary Peters (D-Mich.), chairman of the Committee on Homeland Security and Government Affairs. It found that drug shortages rose by nearly 30% between 2021 and 2022, noting that more than 90% of conventional sterile injections destined for intensive care rely on ingredients from China and India. . According to the report, while the average drug shortage lasts about 18 months, more than 15 key medicinal products have been missing for more than a decade.
“There is a lack of transparency about where the product is made, the source of the raw materials and how many suppliers there are in the market,” says Sutaria.
Health systems like Scripps and Sanford have not had to delay or cancel any procedures due to shortages. Suppliers are asking manufacturers to introduce stronger reporting requirements and ramp up production of critical, widely used drugs and devices to prevent potential interruptions of care.
“Timely reporting can help hospitals know to plan distribution, but reporting alone cannot improve supply.” [levels]’ said Erin Fox, senior director of pharmacy at the University of Utah Health.
