224 - Pharmacy stock of neonatal critical care medications and baby formulas in a tertiary hospital

Poster Number: 224
Publication Number: 224.441

Sophia Tsakiri, McGovern Medical School at the University of Texas Health Science Center at Houston, Houston, TX, United States; Shannon Lavergne, Harris Health System, Houston, TX, United States; Maria D'Souza, Harris Health System LBJ Hospital, Missouri City, TX, United States; Jose Garcia, UTHealth, Houston, TX, United States

Background: Critical neonatal medication and specialty baby formula availability is essential for high-quality patient care in neonatal critical care units.

Objective: An incident of a critical cardiovascular medication shortage triggered our effort to prevent future depletion of critical neonatal medication stocks in our hospital.

Design/Methods: We report a joint neonatology and pharmacy performance improvement project that delineates the needed critical neonatal medications and baby formulas, and the timely review of their availability in order to secure minimum necessary supplies at all times in a hospital providing neonatal critical care. The project occurred in two PDSA cycles. At the first PDSA cycle (November 2021 to January 2022), we revised the pharmacy process for reviewing stock of 14 select neonatal medications and specialty baby formulas. With weekends and holidays as high-risk periods for shortages to appear, a midweekly review of supplies was scheduled. The Pediatric Pharmacist maintained the log of supplies and characterized the supply for each item as adequate, low, or depleted at every review. All low or depleted supplies were then reviewed with the designated Neonatologist. Additional supply procurement, alternative suppliers and alternative treatments were explored, secured and implemented expeditiously. At the second PDSA cycle (February to August 2022), the number of critical neonatal medications and specialty baby formulas reviewed midweekly was revised to 68.

Results: During the first PDSA cycle, 11 medications were in low supply in at least one midweekly review, with 3 of the 11 medications also depleted at least once. Alternative treatments were used for patient care. No patient missed any needed treatments, and no patient harm resulted from these shortages. All medication stocks were restored by the second PDSA cycle. 
During the second PDSA cycle, 115 incidents of low supply of 17 medications or baby formulas, that were identified in at least one midweekly review, were addressed timely, before any stocks were depleted. A baby formula recall by the manufacturer was also addressed promptly. No patient missed any needed treatments or specialty feedings, and no patient harm resulted from these shortages. Since the conclusion of this project, the midweekly stock review of these 68 critical neonatal medications and baby formulas has become standard practice for our hospital.

Conclusion(s): Systematic review of adequacy of critical medication and baby formula supplies allows for timely addressing of shortages, and is part of emergency management for neonatal units and hospital pharmacies.