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Managing risks arising from medicine shortages in NHS hospitals

By David Cousins, Mary Evans and Kevan Wind



To identify and prioritise risks associated with medicine shortages in NHS hospitals, and describe how these risks can be managed more safely.


A failure modes and effects analysis (FMEA)

Subjects and settings

The multidisciplinary group  involved in managing medicine shortages in a district general hospital.


In total there were 61 failure modes identified and scored for the 14 process steps for managing medicine shortages. The failure mode with the highest criticality score was associated with unmanaged risks when an alternative medicine is supplied in the place of the original medicine that is in short supply. New risks can be introduced when an alternative medicine is supplied for use. These range from the new product not being recognised and not used, being mis-selected for another medicine, or where wrong dose, preparation and administration errors occur. Clinical staff may incorrectly assume the alternative medicine product is to be used in an identical way to the medicine in short supply. A risk assessment checklist was developed for use with alternative medicine products intended for replace medicines shortages. The checklist can be used to authorise alternative medicines for safe use in the hospital and provide a clinical governance audit trail for their introduction.


Although it is often not possible to predict when medicine shortages will occur, risks to patient safety and effective processes for dealing with them and communicating internally and externally can be defined beforehand.

Citation: The Pharmaceutical Journal URI: 11104965

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