Infrastructure for Medication Shortage Management

Medication shortage management requires documented policies for therapeutic alternative selection criteria, conservation protocol triggers (e.g., when days-of-supply drops below 7 days, activate restriction protocol), and allocation decision rules for critically short drugs. These must be findable and current—not tribal knowledge held by senior pharmacists. Formulary documentation and P&T committee policies provide this foundation, though individualized clinical judgment for specific patient exceptions remains less formalized.

Shortage impact prediction requires systematic capture of daily inventory levels, usage rates by unit and patient population, purchase orders and receipts, and FDA shortage list updates. Automated dispensing cabinet logs and CPOE order data provide the usage-rate foundation. The system needs template-driven capture ensuring shortage status, estimated days of supply, and conservation protocol activation are recorded with consistent fields for trend analysis and impact prediction.

Shortage management requires consistent schema across drug records: NDC code, current inventory, average daily use, reorder point, therapeutic alternatives with equivalence ratings, and conservation protocol status. RxNorm and NDC standards provide the drug entity foundation. All shortage-related records must share these fields to enable comparative analysis—which drugs are most at risk, which units consume the most, which alternatives are clinically appropriate for which patient populations.

The shortage management system must query current inventory (pharmacy system), daily usage rates (ADC logs and CPOE), FDA shortage list (external API), therapeutic equivalence databases (drug database APIs), and purchasing system (GPO/wholesaler feeds). API access to these systems enables real-time shortage impact prediction. The closed-loop pharmacy integration that already connects EHR, pharmacy, and ADC provides the primary data access pathway.

Shortage predictions become invalid when formulary additions occur, when purchasing contracts change, or when the FDA shortage list updates. Event-triggered maintenance—new FDA shortage designation triggers rule update, formulary addition of alternative drug triggers recommendation logic update—ensures the shortage management system reflects current reality. The P&T committee's formulary governance provides the organizational mechanism for updating therapeutic alternative recommendations.

Shortage management requires API-based connections between inventory management, CPOE/ADC usage tracking, purchasing/GPO systems, FDA shortage databases, and clinical decision support for alternative recommendations. These systems must share data to compute accurate impact predictions—usage data from CPOE combined with inventory from pharmacy plus FDA shortage timeline equals days-of-supply forecast. The existing medication use process integration provides this foundation.