Linking Medication Errors to Drug Shortages: Evidence from Heparin Supply Chain Disruptions Caused by Hurricane Maria

Problem definition : Scant empirical research studies the impact of drug shortages on the quality of medical care in hospitals. We study the causal relationship between drug shortages and medication errors using a natural experiment: hurricane damage to factories that produce heparin, an essential medication used frequently in hospitals. Methodology/results : We collect data on medication errors from the U.S. Food and Drug Administration’s Adverse Event Reporting System and drug sales from IQVIA’s National Sales Perspective. Applying the synthetic control method, we find that hurricane-related heparin supply disruptions increased medication error rates by 152%. In addition, we find significant spillover effects. The disruption increased medication error rates of a substitute drug, enoxaparin, by about 114%. Managerial implications : Our study uses an exogenous event to show that medication supply chain disruptions may negatively impact hospitals’ quality of care. We contribute to the literature by empirically linking the effects of supply chain disruptions to downstream service quality. Our results show that commonly used measures to mitigate the impact of drug shortages, such as substituting medications, may be unsafe. We discuss several measures that hospital managers may consider implementing to mitigate the potentially harmful effects of drug shortages.