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What criteria are used at facilities to determine which patients receive drugs during an extreme drug shortage when only a limited supply is available within the facility? How is this issue communicated to patients, if at all? —Susan Shaw, BSN, RN, OCN, CBCN

A good source of information on this subject is the American Society of Health System Pharmacists (ASHP) guidelines.1 When a drug shortage has been identified, operational and therapeutic assessments need to occur. The operational assessment validates the details of the shortage, determines the stock on hand, determines availability from predetermined alternative sources, estimates the impact on the health system, and determines the availability of alternative drug products. The therapeutic assessment identifies the primary patients affected and determines therapeutic alternatives.1

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In terms of allocating any drug on hand to patients, the intent of therapy should be considered.1 In cases where the intent of therapy is curative and no therapeutic equivalent alternative exists, the remaining drug should be considered for those patients. When a shortage occurs, determine which patients are currently taking the drug and the therapeutic intent. Communicating this information to the oncologist is imperative, and the physician communicates this to the patient. In addition, oncologists should avoid starting any new patients on the drug in shortage. —Sandra Cuellar, PharmD, BCOP ONA


1. ASHP Expert Panel on Drug Product Shortages, Fox ER, Birt A, James KB, et al. ASHP guidelines on managing drug product shortages in hospitals and health systems. Am J Health Syst Pharm. 2009;66(15):1399-1406.