Development of an acuity scoring system to proactively address drug shortages and increase supply chain resiliency

Drug shortages pose a serious threat to the quality of healthcare provided to patients, particularly in a pediatric care setting. The Delphi method was used to develop acuity scores for medication supply chain redundancy planning. We prioritized redundancy measures for medications for which a shortage would result in the greatest disruption to patient care.

The acuity scoring system developed at St. Jude Children's Research Hospital included 4 primary criteria: historical supply disruption, medication unit cost, operational impact, and clinical impact. A list of medications was developed based on disruptive supply distributor patterns and carrying cost classification for inventory valuation. To rank the medications of highest priority, the Delphi method facilitated consensus over 2 rounds of scoring to assess operational and clinical impact. Medications with less than 75% agreement were addressed in the first round, and 80% consensus was achieved in the second round. After weighting operational and clinical impact scores based on cutoff standard deviations, the scores for all 4 primary criteria were combined, with the final aggregated shortage list containing 95 medications and formulation combinations. The top 10 medications of highest priority (acuity) had similar operational and clinical impact scores.

This approach and the proposed scoring algorithm can be used by other institutions to implement shortage mitigation and resilience measures. Future research could assess the reliability of this scoring algorithm for use at other institutions.