For many decades, we were assured of the integrity of the pharmaceutical products that we purchased for preparation and
distribution to our patients. We knew of the product's quality, the source of the product and the price we paid for it.
Simply stated, we were lulled into believing that we seldom, if ever, needed to question a product's integrity. In the
past 5 years, we have faced a virtual assault on the pharmaceutical supply chain, including the following:
- The presence of counterfeit products, drugs and packages that have been adulterated by illicit operators
- Diversion of drug products, sometimes by pharmacy employees and their collaborators, for resale and monetary gain
- The proliferation of questionable drug distributors and wholesalers that make highly suspect products available to us in
times of dire need. This comes at a time of consolidation in the wholesale drug industry, with three large companies left standing
- Dramatic expansion of the scope and scale of drug wholesalers into health service companies with a wide variety of products and services
- Variability of drug product pricing, depending on which class of trade is relevant, often with the result that the same
hospital receives different prices for the same drug for each class of trade
- Drug shortages, unprecedented in complexity and scope
- Changes in the purchasing of drug products and the relationships between group purchasing organizations (GPOs), distributors,
pharmaceutical companies and their customers
These events are occurring at a time when hospitals are forced to reduce their costs of personnel, drugs and supplies, face
manpower shortages and are still expected to dramatically improve the quality of care. We never seem to have enough manpower,
our budget for drugs is strained by new therapies and the number of quality initiatives we must implement can be bewildering.
The challenge for us is to create a new vision for pharmacy practice, one that is patient-focused and clinically driven. We must
demonstrate our value to the patient care process and have expectations that GPOs and our suppliers do the same. The accompanying
articles on drug counterfeiting, the management of drug shortages and the changing nature of GPO and distributor relationships
provide useful details on how to manage these issues and problems.
We are being put in the health system spotlight and our response to all of this attention will have long-term implications for
our role in drug therapy management in the future. Some of the elements to our response should include:
- All of our employees should reflect a passion for quality. All of our training, personal development, position descriptions
and hiring practices should inculcate this value system and commitment to impeccable quality.
- Our decisions should be evidence-based and our information systems should be designed to enhance the quality of our decisions.
Our drug information services should be structured to respond to the collection and analysis of our patient care data on drug
usage. This should guide how we manage patient drug therapy.
- We should adopt technology and information systems to the fullest extent possible and integrate purchasing, utilization, cost
accounting and charging data in order to provide audit and control of drug utilization. Many of us have been able to use
controlled- substance utilization data and compared this with patient care data to identify potentially impaired professionals.
Similarly, purchasing systems should be linked to utilization systems to identify possible diversion. Our control of drugs should
be bank-tight since we manage millions of dollars in drug products each year.
- We must bring our quality focus and the importance of medication safety to the decision-makers in our hospitals, including
medical staff, senior management and boards of trustees. We must develop a patient advocacy for safe and effective drug therapy
and play that important role in our health care community. This will put us and keep us in the spotlight. We must be committed,
articulate and forceful in addressing medication safety in all forums.
- We must set expectations that those organizations with which we do business can document their value on a regular basis and
demonstrate their commitment to our vision. Can they help us assure the integrity, reliability and quality of the drug supply,
and can they demonstrate how they do this?
- We must frame the issues of counterfeiting, diversion and drug shortages as part of our plan to assure medication safety and
quality. These are not simply business and financial problems, but rather issues that can have a profoundly negative impact on
our patients. We must carefully monitor our drug supply and our patients' response to drug therapy to identify potential problems.
- We must implement, as soon as feasible, bar coding technology in our purchasing and receiving operations, as well as at the
bedside to enhance the integrity of our drug supply.
Health system pharmacy has a formidable agenda as we look to the future. Facing new, complex issues with new and innovative
solutions, keeping a clear, laser-like vision on patient quality, we must find business partners that support our new vision
and mission. Professionals have a covenant with society to continuously improve their contributions to that society, despite
new and complicated hurdles. We in pharmacy are up to these challenges and are uniquely skilled to respond.