Pharmacy Supply Chain and Drug Shortage Management Procedures

Teaching someone with no foundational knowledge requires setting clear definitions for procurement methods.
Wholesaler vs. Direct: It is critical to distinguish between purchasing through a third-party wholesaler (who stocks products from various manufacturers) and buying direct from the manufacturer.

Okra Reporting System: All reports are run through Okra to identify specific image-related data issues or other patterns.
Omnicell Data Integration: Okra pulls its primary data from Omnicell.
Virtual Omnicell Concept: Every physical Omnicell unit across the entire facility (including every floor and all carousels) is aggregated into a single "virtual Omnicell." This allows the system to view the entire inventory as a whole.
Inventory Shuffling: In the event of a shortage in one specific Omnicell unit, the system manages inventory by shuffling stock through the broader network of units to ensure availability where needed.

Communication of Drug Shortages: When an actual drug shortage is confirmed, it is communicated through visual and procedural barriers in the clinical workflow.
Epic Integration: Alerts and stops regarding drug shortages are placed directly into Epic (the electronic health record system).
Types of Workflow Interruptions:
- Hard Stop: This occurs when a drug is completely out of stock. It prevents the clinician from proceeding with an order ( $\text{we can't order anymore}$ ).
- Soft Stop: This is a recommendation or guided workflow. It may suggest using the drug only for specific indications or "push" the user toward an alternative therapeutic option. It is not an absolute barrier to ordering but acts as a significant deterrent or guide.
- Simple Alert: A basic informational notification (e.g., "Be mindful") that does not necessarily indicate a critical shortage but provides relevant stock status or awareness.

Shortage Sheet Color Coding: The status of a drug on the shortage tracking sheet is represented by specific colors.
- Yellow Cells: Indicates a shortage duration of over $2$ weeks. A cell remains yellow until it is manually removed from the active short sheet.
- Red Cells: Indicates a shortage duration of less than $2$ weeks (< 2 weeks).
Removal from Shortage Sheet: Once a drug is and no longer on the active short sheet, it ceases to be tracked there to ensure the list remains manageable.

Legacy Drug Shortages Sheet: This sheet serves as the permanent historical record for all items that have ever been on shortage and subsequently resolved.
Data Volume: There are currently $642$ items listed in the history that have transitioned from the active shortage sheet to the legacy sheet.
Functional Workflow:
- When an item goes on shortage, it is tracked on the active sheet.
- When the shortage is resolved, the data column is moved to the Legacy Sheet.
- If a previously resolved item enters a shortage again, the existing data can be moved back to the active sheet to save time and maintain continuity.
Historical Utility: The legacy sheet maintains usage data and documents prior strategies used to manage the shortage, such as:
- Safety-approved use of preservative products.
- Identifying alternative products.
- Removal of stock from specific locations.
- Re-optimization of inventory levels.
New Shortage IDM: This specific sheet is reserved for newly identified or current shortages. Currently, there may only be $1$ , $2$ , or $3$ items in this specific category.
Maintenance Sheet: A specific internal sheet exists solely for maintenance purposes (specifically for use by "Marty") and is not relevant for external presentation or general staff use.

Question (Learner): "If you're explaining to somebody that has no idea, you know I mean… what else will be [important]?"
Response (Presenter): The presenter emphasizes defining the difference between a wholesaler and direct purchasing as the foundational starting point.
Question (Learner): "For those red and yellow cells, when does a cell turn yellow?"
Response (Presenter): Over $2$ weeks. It stays yellow until removed. It is red if it is less than $2$ weeks. If there is no color, it is not on the short sheet.
Question (Learner): "Is [the legacy sheet] the same plan we wanna use?"
Response (Presenter): Yes, the legacy sheet is used to review past actions to decide if the same mitigation plan should be applied to a recurring shortage.