Chapter 3 – Health Care Operations

3.5.19 Medication Shortages or Backorders

• Procedure Overview

  • California Correctional Health Care Services shall maintain a system to ensure that prescribers and other health care professionals are informed when prescribed medications cannot be provided in a timely manner because of inventory shortages, supply system shortages, or backorders.  The system shall include a process to allow prescribers to change therapy when appropriate and to notify health care professionals and patients of the change.

• Purpose

  • To ensure that prescribers have the opportunity to assess the impact on patient therapy and adjust the care plan in a timely fashion when medications are unavailable due to supply system interruptions.

• Procedure

  • When it is determined that a prescribed medication is unavailable from the supplier because of an inventory shortage, manufacturer shortage, backorder, or other reasons, the Pharmacist-in-Charge, or pharmacist designee, shall assess the anticipated duration of delay.

  • The pharmacist shall communicate to the prescriber, or designee, and nursing staff when medication cannot be provided in the expected timeframe due to supply system interruptions.

    • The communication shall include an anticipated timeframe for obtaining the medication.

    • The prescriber shall determine the appropriate response and inform the pharmacist.  The provider shall prescribe an alternative medication or authorize a delay in medication delivery if the timeframe is safe and appropriate. The prescriber shall document the decision to prescribe an alternative medication or authorize a delay in the health record.

    • The pharmacist shall communicate the decision to nursing staff.

    • Nursing staff shall communicate the decision to the patient.

  • The pharmacy shall keep a log of medications affected by the supplier interruption. Every business day, until the shortage resolves, the pharmacy shall reassess the availability of the prescribed medication and alternatives. A resolution for unavailable medications that are needed immediately or urgently shall be completed before the close of that business day.

  • If medication becomes unavailable from the manufacturer for an indeterminate period of time, the Pharmacist-In-Charge shall notify the prescribers, nurses, institution Medication Management Subcommittee, and headquarters Pharmacy Services at cdcrcchcsrxsupplychain@cdcr.ca.gov.

  • If the shortage is significant, the Statewide Chief of Pharmacy Services shall communicate the shortage to the Systemwide Pharmacy and Therapeutics (P&T) Committee.

    • The Systemwide P&T Committee shall determine if an alternative product can be established as a therapeutic substitute for the unavailable item(s) pursuant to Health Care Department Operations Manual, Section 3.5.6, Therapeutic Interchange and Automatic Substitution.

    • The recommendation for alternatives identified by the Systemwide P&T Committee shall be communicated to all facilities.

  • Once the shortage resolves, the pharmacists shall communicate the availability of the medication to the prescriber to make changes as appropriate.

• References

  • Health Care Department Operations Manual, Chapter 3, Article 5, Section 3.5.6, Therapeutic Interchange and Automatic Substitution

• Revision History

• Effective: 01/2009
  Revised: 02/2021
  Reviewed: 06/2021, 03/14/2023, 12/10/2024