​During the pandemic, many nursing homes and other long term care facilities saw supply chain disruptions. While some of these shortages have eased, some supply chain challenges will continue and new ones will arise. There is no one solution, but creativity, partnerships, and some juggling will enable facilities to keep supply chains from breaking.

Before anyone had heard of COVID-19, no one was talking about supply chains, shortages, and the costs of securing or maintaining inventories. Then delays and interruptions made it difficult or even impossible to get basic items, such as N95 masks, gloves, and gowns. Suddenly, supply chain issues were wrecking havoc with staff and resident safety, budgets, workforce stability, and other aspects of care and operations.

“At the beginning of the pandemic, everyone had personal protective equipment (PPE) shortages. We established national and international partnerships. We booked vessels from China to get supplies of masks, gowns, and gloves,” said T.J. Griffin, RPh, vice president of long term care operations and chief pharmacy officer at PharMerica in Louisville, Ky. “This was our focus at the beginning of the pandemic, then our customers started to experience shortages of tests and testing supplies; then we moved from there to the vaccines. We partnered with Walgreens to ensure our facilities were properly scheduled, and we held thousands of clinics to administer boosters.”

Brad Mariam, executive vice president at Medline Post-Acute Care, further observed, “Throughout the pandemic, we focused on implementing new ideas to combat the national shortage of medical supplies.”

Don’t Stockpile, Strategize

During the pandemic, panic led to organizations and consumers alike trying to stockpile items in short supply. This included items such as masks, gloves, cleaning supplies, certain food items and medications, and various other staples.

“Stockpiling as a concept is common, and the pandemic taught us that it can be difficult to manage. Owning a stockpile requires capital and space to store products and constant visibility into inventory so products that are expiring can be rotated out,” said Mariam. “We are seeing a need to develop smarter stockpiles and a process for replenishing and managing stock on behalf of our customers.”

It’s not possible to stockpile supplies for every contingency. You can stockpile some PPE to be able to handle a certain amount of surge, but this can be an expensive proposition. At the same time, some things need to be stored in temperature-controlled environments, and this can be challenging as well.

There are steps that can help keep you from getting caught short-handed without excessive stockpiling:
Be alert and flexible. Have a “go-to” person on your staff, a vendor, or partner organization who has their finger on the pulse of trends and pending problems or crises. Have supply chain strategies that include several options, relationships, and supply sources for basic needs. For instance, Mariam said, “We have several hundred people throughout Europe and Asia who are our boots on the ground and experts in communicating what is happening that can potentially impact operations in the U.S.”

Know what you have. Stay on top of what supplies you have, where they are, and when (if applicable) they expire. Don’t let panic lead you to stockpile more supplies than you have the ability to store or that are likely to expire before you can use them.

Conduct regular supply reviews and needs assessments. Know what you have and what you might need moving forward at any given time. Budget carefully. Weigh the risks and benefits of using credit or reserves for supplies you may or may not need even if the worst-case scenario happens.

Establish and strengthen relationships with suppliers, government offices, and other entities that are likely to have supplies even when there are shortages. For instance, large companies like Medline can coordinate bulk buys and draw from that centralized inventory when they need supplies.

There are ways to help manage costs when supply chain issues send prices sky high. Resiliency, says Mariam, is key. “Resilience is a multi-pronged approach, from sourcing and logistics to products and technology. To help reduce the risk of supply shortages, health systems should look at clinical acceptability as well as clinical preferences,” he said, adding, “In other words, what are the acceptable product substitutions? Their health care supply partner can help by reviewing the clinically preferred products and creating a list of approved substitutions that are similar in nature to help ensure uninterrupted product availability.”

It is also more important than ever, said Mariam, for health care providers to follow proper formularies and guidelines. “Assuring that clinical staff have the proper education around the products they use is an important piece of managing utilization and controlling supply spend.”

This all requires a careful balance. Anna Fisher, CMDCP, CDP, QCP, director of education and quality at Hillcrest Health Services in Nebraska, observed, “At the height of the pandemic, we sometimes had to reuse N95 respirators that were meant to be used just once. We had to develop protocols for this, and we had to do so with a safety mindset that balanced tried-and-true infection prevention and control strategies with what PPE was available.”

Collaborate Through Coalitions

There’s safety and strength in numbers; and particularly during times of widespread supply shortages, sharing resources, supports, and connections can benefit everyone involved. For instance, states like Nebraska have health care coalitions, which are groups of individual health care and response organizations—such as hospitals, emergency medical service providers, emergency management organizations, public health agencies, and others—working in a defined geographic location to prepare for and respond to disasters and emergencies.

Such coalitions enable its members to collaborate and ensure each member has what it needs to respond to emergencies and planned events. This may include medical equipment and supplies, real-time information, communication systems, and educated and trained health care personnel.

Justin Watson, MPA, healthcare collation coordinator for the Omaha Metropolitan Healthcare Coalition, said, “During the pandemic, a lot of people thought the federal government would come in and save the day.” A coalition is important because it brings together individuals and organizations with a variety of strengths and resources for shared decision-making and action.

Early on, Watson said, “We put together a workgroup of infection preventionists to address PPE reuse and safety.” As a result, they implemented solutions such as setting up ultraviolet lights in communities that allowed for decontamination of N95 masks that enabled safe reuse.

Are We Done Yet?

While the pandemic has eased considerably, supply chain shortages continue to plague facilities. For instance, Griffin said, “We are battling some supply chain issues now regarding saline and saline flushes.”

These products are being rationed to a degree, with orders being set and limited by customers’ history of purchases, that is, you can’t order significantly more saline today than you have in the past. “We’ve partnered with vendors nationally and internationally to maximize our access to saline. We are able to move things around because we are a large company,” he said. This is an example where partnerships and relationships with large international organizations and those with a wide reach can help when there are supply shortages.

There are always some medications that are in short supply, but this is a bit easer to track. Griffin said, “The FDA sends out weekly notices showing the status of shortages, expected returns, etc. There also is a drug shortage database where you can search drugs alphabetically to see where things are.” At the same time, he said, “If there is a shortage that could affect patient care, the pharmacy can work with physicians to potentially get orders changed to viable, more easily accessible alternatives.”

Griffin cautions that availability of some products can turn on a dime. For instance, he said, “There may be a shortage of various sterile products because of manufacturing difficulties. All it takes is one manufacturing facility with a quality issue to disrupt supply.” Elsewhere, he observed, “Sometimes you run into drug shortages at year end, such as those medications with annual manufacturing and shipping limitations.”

To help prevent shortages of medications and related supplies, Griffin stressed the importance of communicating needs in advance with the pharmacy. For example, he said, “If you are going to dramatically increase your admission of IV patients or other high acuity residents with specific needs, it would be helpful to inform the pharmacy so they can make sure they have the medications and products you need.”