The Reality of Medical Inventory

Lee Herold, DVM, DACVECC, discusses the annoyance of medical inventory backorders and gives tips for dealing with drug shortages.

Views: 8847 - Comments: 5

You are here

Many of us have experienced the frustration of dealing with the revolving door of drugs or inventory items that are in short supply, on backorder, or have been discontinued. Within the past two years we've seen this with drugs we may use every day like buprenorphine and propofol; on other drugs that are the only drugs available to treat a specific condition, such as immiticide to treat heartworm disease, and within the past two years we said goodbye to Vetsulin insulin. The situation is difficult during the practice of medicine but they affect our business by increasing the cost of finding alternative therapies. Probably most important is that limited drug availability might compromise patient care. While many of the reasons are out of our control, there are some proactive things we can do:

Medical Inventory

  1. Be informed
    • The United States Food and Drug Administration (FDA) maintains a website to track and report drug shortages. Those tracked are primarily for humans, but It ties in with veterinary medicine since most of the drugs we use are off label human drugs.
    • Veterinary biologics and pharmaceutical shortages are not tracked as closely as human pharmaceuticals but the FDA’s center for veterinary medicine can also be a resource.
    • Pay attention to online resources such as the Veterinary Information Network (VIN). This global online veterinary community can alert us to shortages of drugs in different parts of the country or the world that might eventually make its way to affect the suppliers in your area.
  2. Try to find alternative sources
    • This may mean establishing partnerships with different veterinary distributors. One distributor may be able to provide you with a supply of product because of differences in their inventory and warehouse stocks, whereas another may already have the product on backorder. It's worthwhile to establish new business relationships as a contingency plan for short supply.
    • Explore compounding pharmacies as an option for prescribed medications. Though using compounding pharmacies should always be done with a bit of caution due to quality control of the drugs being compounded, they can certainly be a good alternative when traditional sources of the drug are less available. For example, when buprenorphine was recently in short supply, the in–house stock was reserved for hospitalized patients, and we called in more prescriptions to compounding pharmacies for those cats we sent home on buprenorphine. It is an additional stop for the client, but most understand since they fill their own prescriptions pharmacies--not at their physician’s office.
  3. Inventory the supply on hand and try to project how long it will last
    • Some causes of short supply will have a predictable duration. The manufacturer or distributor may be able to predict when the product will come off of backorder. If you have enough in stock such that your usage of the product will not outpace the duration of the backorder, you may not need to worry about finding alternatives. You can rest easy and just continue to monitor your in–house supply and the return of supply from your distributors.
  4. Find alternative therapies
    • As clinicians, we get comfortable with the drugs and medications that we use most often, but rarely is there only one option or choice of treatment for a particular condition. Short supply and backorder can force us to expand our comfort zone, but you may you can re–acquaint yourself with an “oldie but goodie,” or learn about a new drug that you like better. For example, when propofol was recently in short-supply, and we wanted to reserve it for those patients that needed it most, we renewed our familiarity with Ketamine/Diazepam induction protocols that resulted in less hypotension than propofol induction. Many on our staff became familiar with etomidate inductions, which we always had in our hospital but rarely used in favor of propofol (before it became backordered). Most found that with the right neuroleptanalgesia protocol, the etomidate inductions, were equally smooth as those with propofol and again less hypotension was encountered. Whatever alternative you find, it will take some staff education and training to gain the same familiarity as with the old drug. Time, experience and steady guidance from your senior staff can ease the transition. Any increase in versatility in the practice of medicine will be an overall good thing.
  5. Prioritize usage of short supply medications
    • This goal can be one of the most difficult to implement in practice. In multi–doctor practices, how can I possibly know whether Dr. X’s patient needs this medication more than Dr. Y’s patient--or my patient? How do I know whether in the future I will see a patient who needs this medication more than the patient I am currently seeing? Answering this priority question becomes most important when there are no other alternatives for treatment. In multi–doctor practices it might be helpful to reach a consensus or establish criteria for usage of the medication anyone can then refer to when a patient or case comes up. It may be helpful also to have patients or cases reviewed through a single individual or committee to determine if they qualify for usage of the drug. Even when we establish these protocols, there will remain those cases in which we question our decisions. In these cases, we must remember that above all else we must act in good conscience for our current patients and clients in making this priority.

What’s your most annoying current backordered drug?

Sidebar Bookmark Button


Add To Training Plan


Content Assignment



Megan Brashear's picture

Oh Pat, we are for sure feeling the pain of no fentanyl! Thank goodness for MLK but nothing quite works as well (and is as easy to calculate!) as my best friend fentanyl CRI. We're hoping for a quick recovery on that one!

Terrie Corcoran's picture

Friendly Butler Schein rep here, we currently have lots of Fentanyl (inj. came in earlier this month), We have all sizes of patches too. :)


Michael Murphy's picture

Many thanks to the compounding pharmacies. The felines of the world thank you.

Samantha Braswell's picture

Adequan! Prednisone is hard to find too.. and when we do, the cost is much higher..