Adrenaline auto-injectors (AAIs) – A shortages case study


What are AAIs?

Life-saving medicines that people carry with them in case there is an emergency, such as a potentially life-threatening allergic reaction to stings or certain foods (e.g. nuts).

What was the issue?

A shortage of one particular brand led to increased demand for other AAIs, which coincided with the seasonal increase in demand for all AAIs linked to the seasonal vaccination and back-to-school periods. This led to supply constraints for AAIs in the second half of 2018.

What was the benefit of the multi-stakeholder framework?

  1. The HPRA, in collaboration with the other AAI suppliers and healthcare professionals, were able to respond quickly and establish the potential gap in supply as soon as the potential shortage was identified. This allowed a number of actions to be taken prior to the seasonal increase in demand.

  2. Alternative AAI suppliers were advised of the anticipated increased demand for their products in advance so that they could increase production and supply to Ireland to fill the gap left by the shortage. This communication continued during the period of supply constraints to ensure mitigation of the shortage.

  3. The HPRA liaised with the pharmacy regulator, hospital pharmacy medication safety networks and the community pharmacy representative body to provide information on the supply issues so that appropriate guidance and information could be disseminated to pharmacists to ensure a pragmatic response to the shortage.

  4. The HPRA maintained regular communication with specialist prescribers who provided clarification to colleagues on appropriate prescribing of AAI strengths.

  5. As some patients may have received an alternative AAI that they may have been previously unfamiliar with, communications highlighted that patients and their carers should become familiar with the new device and that pharmacists could provide advice in this regard at the point of dispensing.

  6. The shortages section of the HPRA website was updated regularly with information on the supply and became a ‘go-to’ site for information to patients and healthcare professionals.

Was Ireland the only country impacted?

The supply constraints were a global issue that impacted many countries, including the USA and the UK. Whilst the supply situation in Ireland was challenging, the actions taken ensured that a suitable AAI was available to dispense to patients at all times which is in contrast to the situation observed in other countries.