Position Paper on Drug Shortages

• using evidence-based strategies to minimize the impact of drug shortages by maximizing efficiency and eliminating waste through interventions such as – grouping patients receiving the same therapy into cohorts to share vials during drug preparation – reducing advance preparation of drugs that may lead to waste – using safe dose-rounding practices to eliminate waste – evaluating drugs’ expiration times and shelf life to extend the period of safe drug use • developing institutional interdisciplinary drug allocation committees that – include physicians, pharmacists, nurses, social workers, members of institutional ethics committees, and patient repre- sentatives – apply ethical decision-making principles – explore reasonable therapeutic drug alternatives – make prioritization decisions that are applied equitably to patients affected by drug shortages – provide an appeal process for patients and families who have been affected by drug allocation decisions • showing respect for patients and caregivers by informing them about drug shortages and the process by which allocation decisions are made. The Association of Pediatric Hematology/Oncology Nurses does not support • unethical practices (such as drug hoarding or discrimination based on patients’ age, devel- opmental level, ability to pay, race, ethnicity, disability, or immigration status) that violate the principle of justice

• unsafe strategies of waste reduction, such as those that violate infection prevention protocols (e.g., re-using drugs, administering expired drugs) or compromise quality of care. The Association of Pediatric Hematology/Oncology Nurses recommends that nurses • become informed both about the causes and impact of drug shortages and about current recommendations to prevent or reduce the impact of drug shortages on public health • advocate for and participate in institutional drug shortage and allocation committees • ensure that families receive current and re- liable information about drug shortages and the subsequent management plan for their child’s care • refrain from implementing individual strat- egies (e.g., drug hoarding) that, although well-intentioned, may compromise the deliv- ery of safe, ethical, and high-quality care • acknowledge the distress that clinicians experience when forced to implement drug allocation decisions that negatively affect individual patients and families • provide support and therapeutic communica- tion to patients and families whose treatment is altered because of an insufficient drug supply • become involved in public policy advocacy that strives to minimize drug shortages.