Drug Shortage: A Transdisciplinary Team Approach to Injectable Vitamin K Shortage for Newborns
Title: Drug Shortage: A Transdisciplinary Team Approach to Injectable Vitamin K Shortage for Newborns
- Describe the current state of drug shortages in the United States.
- Identify challenges and strategies to the implementation of a response to an injectable Vitamin K shortage for newborns.
- Identify the key stakeholders in an interdisciplinary team to address the shortage.
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.
Proposed change:
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 that 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 and health care providers on management plan, ethical considerations for rationing of supplies, and communication strategies for all administrators, care providers and patients. Linked to the success of the program was 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 babies in the NICU and high risk infants.
Tools developed to support the model of drug shortage response include: color coding system of drug supply for pharmacy and 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 babies, 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 effected. The response to drug shortages is best conducted with a proactive rather than reactive approach in order to have in place the ingredients for an appropriate controlled response.
Keywords:
Vitamin K shortage, Transdisciplinary Team, Collaborative response