How Drug Shortages Disrupt Pediatric Care

The data is no longer eye-opening. Five years after a Vizient and Children’s Hospital Association (CHA) report detailed the detrimental effects of drug shortages on children’s hospitals, a new survey finds not much has changed. In 2023, pediatric facilities experienced shortages of 84 drugs, straining their budgets, staffing, and patient care.

“Drug shortages have remained consistently high every year,” said Terri Lyle Wilson, vice president of pharmacy services at the Children’s Hospital Association (CHA). “This report confirms it has become the norm, and children’s hospitals are making mitigation efforts a priority.”

Shortages disproportionally impact pediatric hospitals, which faced at least 25% more shortages than general facilities. Because drugs for children are unique and children make up a smaller portion of hospital patients, there are fewer manufacturers, making the pediatric supply chain especially vulnerable. As a result, they face shortages of more drugs and have higher expenses related to managing shortages.

In the survey, 79% of pediatric facilities said they exceeded their budgets due to drug shortages, some by up to 30%. Ultimately, shortages resulted in $900 million in financial implications in 2023 alone. Those costs can lead to “compromised patient care, delayed treatments, increased health care costs, and potential disruptions in the overall health care delivery system,” the report said.

Managing supply to prevent disruption to patient care requires considerable time from hospital staff. Compared to 2019, pharmacy staff and purchasing agents spent twice as much time managing shortages in a week, up to 25 hours. A fifth said they had to hire additional pharmacy buyers to manage the shortages, while others had to shift the workload onto already-strained staff amid a severe industry-wide workforce shortage.

“Pediatric facilities have faced the greatest financial and labor strain,” the report noted.

Beyond costs and staffing, the unavailability of certain drugs can result in suboptimal treatments for patients. The top shortages of 2023 included drugs for cancer, anesthesia, and antibiotics. In total, nearly 50% of essential pediatric medications were in shortage in 2023. If not available, these medications prove the greatest threat to a hospital’s ability to provide immediate and high-quality patient care.

Additional findings from the survey include:

• 43% of respondents indicated medication errors that had occurred were related to drug shortages, up from 38% from the 2019 survey.
• 27% of respondents reported that drug shortages caused disruptions in patient care, including 32% of planned medical procedures and 22% of hospital admissions.

What can be done to address drug shortages?

In the survey, hospitals shared a variety of mitigation strategies, including having dedicated staff to handle drug shortages, using shortage management software, and incorporating AI.  

“Though drug shortages have gotten worse over time, our hospitals have gotten better,” Wilson said. “They’re constantly working to reduce supply spend, advance supply chain efficiencies, and improve organizational effectiveness.”

CHA helps children’s hospitals mitigate acute shortages, working with manufacturers, government agencies, and other supply chain players to find solutions and coordinate the appropriate resources.

For example, when a hurricane knocked the nation’s largest manufacturer of IV fluids offline, we worked with the manufacturer to ensure children’s hospitals received priority allocation. When a shortage of albuterol coincided with an uptick in off-season respiratory syncytial virus (RSV), flu, and COVID-19, we worked with an outsourcing facility to manufacture the drug to cover the shortage — and that facility is now a primary supplier of the drug today.

CHA also supports efforts to strengthen and stabilize the nation’s supply chain to forestall shortages. It’s crucial that solutions to drug shortages place a strong emphasis on research, development, procurement strategy, and guidance that can ensure timely access to sufficient pediatric-appropriate supplies.

“In the end, it’s going to take everyone involved in the supply chain to reduce shortages and their detrimental effects on child health and the health care system,” Wilson said. “Transparency, resiliency, and collaboration are the only way forward.”