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A Crisis is Coming: How Will You Communicate About It?<p>​In the world of long term care, how leadership communicates about a crisis can be as fraught with reputational risk as the crisis itself. Being prepared with a robust crisis communications plan is as important as having an incident response plan ready.</p><p>The onset of the COVID-19 pandemic provided a prime example. Administrators of long term care centers were forced—nearly overnight—to respond to a virtual onslaught of evolving information and realities with strategies to protect staff and residents from the illness and its far-reaching impacts. Leadership was under pressure to draft and communicate consistent internal and external messaging to staff, residents, and their families—and often the media—about COVID-19 outbreaks, shortages of PPE or staff, COVID testing and vaccine availability, protocols, and so on, all while what was known and believed to be true was constantly in flux.</p><h3>A Plan for Any Crisis</h3><p>The pandemic highlighted the need for leadership to have a strategic plan to guide crisis communications. But the pandemic is also a useful example of the need for LTC leaders to have in place a communications plan for a variety of crises. A resident elopes. A staffer is accused of stealing residents’ property. A patient’s family claims the facility failed to protect their loved one from an assault by another patient. A Centers for Medicare &amp; Medicaid Services (CMS) survey leads to an immediate jeopardy (IJ) determination, a falling CMS Five-Star rating, and a whopping fine. Don’t kid yourself. If it’s happened elsewhere, it can happen to you.</p><p><img src="/Topics/Guest-Columns/PublishingImages/2022/AllisonPerrine.jpg" alt="Allison Perrine" class="ms-rtePosition-1" style="margin&#58;5px;width&#58;137px;height&#58;178px;" />Sometimes the facility itself is the victim&#58; A fire, flood, or power outage requires residents to be relocated. An infectious disease outbreak impacts staffing levels. An elected official unfairly targets the facility for political gain.</p><p>Facility leadership can and should have language drafted that speaks to an incident in general terms, before it happens. Communications professionals refer to these as “holding statements.” A pre-existing holding statement can be released quickly while the facility digs deeper to learn more, and it can be more easily tailored to address the actual circumstances than having to craft a statement from scratch. If you’re wondering why you need to respond to the inquiry at all, consider the mind of the public, “No comment” means “I’m guilty.” Keep in mind you can’t respond to inquiries from other residents, family members, or staff with “No comment.”</p><p>Communications missteps—whether by speaking too soon or too late or not at all, by giving competing messages to different audiences, or by a host of other means—can upend a facility’s good work, undermine employee relations and morale, and call into question leadership’s commitment to the welfare of its residents, patients, and their families. It can impact recruitment and retention of staff, and it can impact census.</p><p>It's equally important to communicate clearly and effectively internally. Often, when faced with a reputation-stressing crisis, the focus is external&#58; the news media, for example. It’s crucial to communicate effectively with internal audiences as well. In a time of crisis those closest to the organization can also be its best supporters and advocate—if they feel included and valued. It’s critical that leaders prioritize internal messaging so that as soon as a situation arises, information can be sent out as appropriate—with consistency across messaging. This is key to ensure everyone gets the same information and that it is accurate.</p><h3>Coordinating Stakeholders</h3><p>Depending on the circumstance, additional stakeholders may need to get involved in a facility crisis such as fires, floods, or power outages. Facility leaders should be prepared to communicate with elected officials, emergency response agencies, and members of the media about the source and status of the event. Partner facilities and vendors may even need to be brought in if the incident requires that residents be temporarily relocated. Make a list in advance and come up with a plan for outreach. </p><p><img src="/Topics/Guest-Columns/PublishingImages/2022/WarrenCooper.jpg" alt="Warren Cooper" class="ms-rtePosition-2" style="margin&#58;5px;width&#58;137px;height&#58;175px;" />Establish relationships with local elected officials, hospital and emergency response directors (including law enforcement), and local reporters who cover seniors or long term care before a crisis occurs. Having those relationships set in advance can make the difference between positive and negative outcomes.</p><p>Additional stakeholders to keep in mind for communication outreach are referral partners. If a facility receives a low CMS score, an IJ, or a fine, for example, it may stir up hesitation from referral partners as well as donors, elected officials, and families who are deciding whether they want to entrust their loved ones in its care. On top of that, a low score can mean costly fines for the facility. Without swift, consistent messaging, complications may arise—and fast.</p><h3>Advance Planning Is Critical</h3><p>Not all crises are so extreme, but such communications need to be swift, accurate, and impactful. Even minor missteps are important to prepare for, such as delayed response times or poor food quality. Developing a crisis communications plan can be a sure way to check all the boxes. Who will be the media spokesperson? How will inquiries be passed up the food chain? Who will make decisions about how—or whether—to go public in advance of another agency sharing the news? These are all questions a proactive communications plan can address ahead of time.</p><p>A thoughtful communications strategy with the proper protocols in place in advance will help LTC leaders to successfully navigate the early stages of an actual or potential crisis. Legal and crisis communications consultants should be identified ahead of time. As with local elected officials and others, establishing a relationship before its needed can help accelerate an effective response when it’s most needed. Contact information should be at the ready, among your cell phone contacts, and in cellphone directories of your upper management team as well.</p><p>You may not need it today, or tomorrow. But you will, and likely sooner than you think.<br><br><em>Allison Perrine and Warren Cooper are principals at Kessler PR Group, the a New York-New Jersey metro public relations firm specializing in crisis communications, reputation management, litigation support and media relations.</em></p>2022-09-20T04:00:00Z<img alt="" src="/Breaking-News/PublishingImages/740%20x%20740/leadership.jpg" style="BORDER&#58;0px solid;" />ManagementAllison Perrine and Warren CooperIn the world of long term care, how leadership communicates about a crisis can be as fraught with reputational risk as the crisis itself.
A Model of Quality Care During Transitions<p><strong class="ms-rteForeColor-2">ADVERTORIAL</strong></p><p>The Continue Care transitional care management program, created by PharMerica and BrightSpring Health Services, aims to address the gaps in care that exist when an individual is transitioning from a skilled care facility to their own home. Though the program officially launched in May 2022, its development has been underway for much longer, gaining evidence of its impact on the quality of care offered to individuals during critical times of transition. <br></p><p>At its core, Continue Care integrates seamlessly into a facility’s discharge planning process to extend care management into the home by offering a dynamic set of services and solutions that promote medication therapy optimization and nurse engagement at all levels of care. These include 44 days of medications provided post-discharge with most providers, including an initial 14-day supply of medications at the time of discharge; weekly check ins from a nurse starting within 48 hours of arriving home; in-home visits from nurse practitioners (NPs) where available; and 24/7 virtual nurse and pharmacist support for residents and families.<br></p><p><img src="/Monthly-Issue/2022/SeptOct/PublishingImages/ElizabethBurns.jpg" alt="Elizabeth Burns" class="ms-rtePosition-1" style="margin&#58;5px;width&#58;150px;height&#58;188px;" />Conceptually, the Continue Care transitional care management program has gained support from key industry leaders. To add more demonstrative proof of its impact on quality care, PharMerica partnered with Avamere, a leader in&#160;post-acute&#160;and&#160;senior&#160;living, to pilot Continue Care’s transitional care management program. Under the leadership of Dr. Elizabeth Burns, Chief Medical Officer at Avamere, the company launched Continue Care’s pilot program to support its goal of increasing quality care and the patient experience. <br></p><p>“One of the core missions of Avamere is to pursue innovation, not emulation,” said Dr. Burns. “That mission made the decision to join the Continue Care program an easy one.”<br></p><p>Like many centers, Avamere was seeking solutions to address key areas of quality care, including reducing hospital readmissions, improving medication adherence at home, preventing emergency hospitalizations, and&#160;providing&#160;care&#160;in the home for those who need a higher level of assistance. <br></p><p>“Our&#160;goal is&#160;to improve the&#160;quality of seniors’&#160;lives,” said Dr. Burns. “That requires that we&#160;set each person in our care up for success whether they are staying at one of our senior living facilities or discharging from our&#160;post-acute care centers. The Continue Care program breaks down barriers for safe and effective transitions in the home while improving the well-being and experience of patients and residents.”<br></p><p>While the pilot overall has been a success thus far, three specific areas of Continue Care’s program are supporting Avamere’s goals of setting patients up for long-term success&#58; <strong><br></strong></p><p><strong>Primary Care Hub&#58;</strong> Where available, the Primary Care Hub offers NP-led care within the facility itself to partner with staff to develop a proactive care path.<br><strong>Clinical Nursing Hub&#58;</strong> The Clinical Nursing Hub offers care navigation into the home, monitoring, and triage tools designed to address risks and improve outcomes in real time.<br><strong>Pharmacy Packaging&#58;</strong> Continue Care provides convenient multi-dose pillow packaging of prescription medications organized by administration time, synchronized into 30-day cycles with clear instructions to increase adherence and reduce confusion.</p><h3>Primary Care Hub </h3><p>Honoring Continue Care’s goal of creating a model that positions individuals for the best care possible along all stages of the care continuum, Continue Care integrated aspects of BrightSpring’s home-based primary care services into Avamere’s trial through the Primary Care Hub. This in-facility service is a patient’s initial interaction with a care team, beginning the day of admission and continuing through discharge. From this early interaction, care providers can spend time getting to know the patient, their medical diagnoses, and complications, and better understand what the best proactive care plan should be for that specific individual. <br></p><p><img src="/Monthly-Issue/2022/SeptOct/PublishingImages/ArifNazir.jpg" alt="Arif Nazir" class="ms-rtePosition-2" style="margin&#58;5px;width&#58;150px;height&#58;188px;" />“This partnership between home-based primary care and Continue Care is being developed to offer all care providers a great understanding of a patient,” said Dr. Arif Nazir, Chief Medical Officer, Primary Care, at BrightSpring Health Services. </p><p>“We’re focused on proactive care, which relies a lot on communication between care providers as well as taking time and resources to better educate patients about their own medical care.”<br></p><p>Based on initial observations, BrightSpring’s proactive care models within the Continue Care program can help better identify specific medical issues that need attention before they require reactive care. This is particularly important in the Continue Care program, where patients will have complex co-morbidities. While certain technological components are still being developed, BrightSpring’s team-based process requires collaboration between in-facility care teams and the transitional care management teams of Continue Care, as well as educating the patients themselves.<br></p><p>The Primary Care Hub overlay includes&#58;<br></p><ul><li>A NP-led care program to partner with facility staff.</li><li>A risk-stratified, proactive care path-based model to meet individualized medical and psychiatric needs.</li><li>NPs/physician assistants (PAs) supported by care navigators to assure care path compliance.</li><li>Weekly grand-rounding processes to enhance staff competencies and to promote team learning.</li><li>Integrated, high-quality 24/7 call center to answer staff and family questions and prevent hospitalizations.</li><li>Timely outcomes reporting for all stakeholders.</li><li>Chronic disease management and behavior health integration programs.</li><li>Advance care planning on admission and then periodically.</li><li>Polypharmacy optimization and deprescribing.</li></ul><p>“Incorporating home-based primary care is what makes this model incredibly innovative in advancing the care delivery upon discharge, wherever you call home” said Dr. Burns of Avamere. “The Primary Care Hub with Continue Care allows a successful transition to home where patients will get the highest level of care at the right place at the right time along their care journey.”<br></p><p>The pilot program at Avamere is still on track, providing critical data points that will help other centers around the nation successfully integrate Continue Care into their facilities. For more information about the Continue Care transitional care management program, visit <a href="http&#58;//www.pharmerica.com/ContinueCare" target="_blank">www.PharMerica.com/ContinueCare</a>. <br></p>2022-09-01T04:00:00Z<img alt="" src="/Topics/Special-Features/PublishingImages/2022/ContinueCare_PharMerica.jpg" width="1248" style="BORDER&#58;0px solid;" />ManagementContinue Care integrated aspects of BrightSpring’s home-based primary care services into Avamere’s trial through the Primary Care Hub.
Special Needs Plans Improve Care and Access<p><img src="/Monthly-Issue/2022/SeptOct/PublishingImages/SteveFogg.jpg" alt="Steve Fogg" class="ms-rtePosition-2" style="margin&#58;5px;width&#58;150px;height&#58;188px;" /><em>Steve Fogg, chief financial officer of Marquis Companies, has been in the long term care industry since 1986 as part of a multi-generational family business in Oregon. Marquis Companies became actively engaged in population health management (PHM) in 2015, which led to the launch of its institutional special needs plan (I-SNP) named Ageright Advantage Health Plan. </em>Provider<em> magazine spoke with Fogg to talk about the growth of SNPs, how SNPs improve care access, and validation of the care model during the pandemic. </em><br><br><em class="ms-rteForeColor-8"><strong>Provider</strong></em><strong class="ms-rteForeColor-8"> magazine&#58;</strong> Despite the pandemic, long term care provider-led I-SNPs grew from 9 percent of all I-SNPs in 2015 to 33 percent in 2020 and 37 percent in 2021. What are you observing now about the prevalence of long term care provider-led I-SNPs? Where do you think the market will be in 5 to 10 years?<br><strong class="ms-rteForeColor-2">Steve Fogg&#58; </strong>Provider-owned SNPs were probably the fastest growing segment in long term care prior to the pandemic. The desire for providers was to elevate physician services, advanced practice clinician services, and to be able to drive a better experience and outcomes. Provider-owned plans grew in terms of market share, but if you look at membership, the number of individuals that are insured under these plans, it’s not nearly as aggressive. During the pandemic, the rate of growth was not as high as it could have been. As we head out of the pandemic, there’s no reason why we won’t continue to see growth in this space with more providers wanting to enter into SNPs.<br><br><strong class="ms-rteForeColor-8">PM&#58;</strong> How is the workforce crisis affecting long term care provider-led I-SNP availability?<br><strong class="ms-rteForeColor-2">SF&#58; </strong>With the workforce shortage in general, the challenge has become so acute for providers that providers have deferred making the decision to start their own SNP. It’s slowing down the rate at which provider-owned plans and special needs plans are growing. <br></p><p>In the advanced practice clinician space, we’ve noticed that finding physicians and advanced practice clinicians hasn’t been nearly as difficult as finding nurses. We’ve found that there are physicians and advanced practice clinicians that are migrating to long term care because they like the day-to-day work environment versus a hospital or medical clinic environment. <br></p><p><strong class="ms-rteForeColor-8">PM&#58;</strong> What challenges and opportunities in managed care do you see going forward?<br><strong class="ms-rteForeColor-2">SF&#58;</strong> When I say managed care for long term care, I’m including not only the provider-owned SNPs, but also Medicare Advantage (MA) contracting. You’re going to continue to see managed care organizations increase their membership. Over the last 20 years, you’ve seen the over-65 population gradually migrating to managed care. There will be continued challenges in understanding what levels of reimbursement we need to be viable and to continue to provide services to our residents.<br></p><p>The other thing that you’re going to see around PHM is more MA plans subcontracting the management of population health. Those contractors will bring in automation, technology, and workforce to be more effective in managing the population health to provide better outcomes. <br></p><p>A huge opportunity or a challenge for certain providers will be that as MA plans continue to get greater and greater market share with those over 65, these subcontracting relationships could lead to limiting the network of facilities that they work with.</p><p><strong class="ms-rteForeColor-8">PM&#58;</strong> What are the differences in rural vs urban long term care provider-led I-SNPs? Do these plans increase access to long term care in rural areas?<br><strong class="ms-rteForeColor-2">SF&#58;</strong> Without a doubt, one of the significant advantages is the ability to bring a plan into rural facility locations. To bring in a physician or an advanced practice clinician that is in the building every day provides a resource where there may be no such resource in that rural community. In the counties where we have rural facilities, our membership penetration is almost 100 percent. It has improved the overall model of care and services provided to that rural group, so it’s a huge advantage. </p><p><strong class="ms-rteForeColor-8">PM&#58; </strong>According to a 2021 report from ATI Advisory, successful long term care provider-led I-SNPs require strong leadership, accountability, and oversight. How can long term care leaders get buy-in and alignment to succeed with these plans?<br><strong class="ms-rteForeColor-2">SF&#58; </strong>Without a doubt, the most important part is driving a culture of why this SNP will be beneficial for their facilities and for their residents. The team needs to understand that the physician or advanced practice clinician is there to give you a higher level of clinical capability to manage your residents in a more rapid and effective way as they have changes in condition and other issues.</p><p><span class="ms-rteForeColor-8"><strong>PM&#58; </strong></span>Did COVID provide any lessons learned for the model of care for the future? Did it shift how managed care is/should be done?<br><span class="ms-rteForeColor-2"><strong>SF&#58; </strong></span>We had two big lessons come out of the pandemic. First, having up-to-date and complete advanced care planning documentation in your facilities with your residents was critical during the pandemic. We were current and up-to-date on our advanced care planning with our residents, which allowed us flexibility and allowed us to make the right decisions that were best for the resident versus immediately sending an individual to the hospital. <br></p><p>The second thing we learned was the family members of our residents had security and comfort knowing that there was a physician or an advanced practice clinician in our buildings at a time that they were not able to come in and see their loved ones. Being able to talk to that level of professional if there were issues with their loved one was a huge benefit for them and us. It added to the family members feeling like their loved ones were in an environment that was more secure and capable of caring for them. <br></p><p>During the pandemic, there was not any reason to think that we should change the model of care, and in large part, COVID validated the importance of and why the model of care works well. </p><p style="text-align&#58;center;"><img src="/Monthly-Issue/2022/SeptOct/PublishingImages/MarquisCompanies_2c.jpg" alt="" style="margin&#58;5px;width&#58;125px;height&#58;111px;" />&#160;&#160;&#160;&#160; <img src="/Monthly-Issue/2022/SeptOct/PublishingImages/MQ_AgeRight_Advantage.jpg" alt="" style="margin&#58;5px;width&#58;125px;height&#58;37px;" /><br></p><p><br></p>2022-09-01T04:00:00Z<img alt="" src="/Monthly-Issue/2022/SeptOct/PublishingImages/SteveFogg.jpg" style="BORDER&#58;0px solid;" />Population Health ManagementProvider spoke with Fogg to talk about the growth of SNPs, how SNPs improve care access, and validation of the care model during the pandemic.
Balancing the Components of a Supply Chain<p><img src="/Monthly-Issue/2022/SeptOct/PublishingImages/supply.jpg" class="ms-rtePosition-2" alt="" style="margin&#58;5px;width&#58;300px;height&#58;300px;" />​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.<br></p><p>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.<br></p><p>“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.” <br></p><p>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.” </p><h3>Don’t Stockpile, Strategize</h3><p>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. <br></p><p>“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.”<br></p><p>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.<br></p><p>There are steps that can help keep you from getting caught short-handed without excessive stockpiling&#58;<br>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.”<br></p><p>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.<br></p><p>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.<br></p><p>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.<br></p><p>There are ways to help manage costs when supply chain issues send prices sky high. <a href="/Monthly-Issue/2022/SeptOct/Pages/New-Rules-Require-Resiliency.aspx" target="_blank">Resiliency</a>, 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.”<br></p><p>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.”<br></p><p>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.”</p><h3>Collaborate Through Coalitions</h3><p>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. <br></p><p>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. <br></p><p>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. <br></p><p>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.</p><h3>Are We Done Yet?</h3><p>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.” </p><p>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. <br></p><p>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.”<br></p><p>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.”<br></p><p>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.” <br></p>2022-09-01T04:00:00Z<img alt="" src="/Monthly-Issue/2022/SeptOct/PublishingImages/supply.jpg" style="BORDER&#58;0px solid;" />ManagementJoanne KaldyStrategies, coalitions, and communication are the keys to a flexible supply chain.