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Medication Delivery Delays Prior to and During the COVID-19 Pandemic at the Manila Outpatient Clinic in Pasay City, Philippines

Report Information

Issue Date
Report Number
20-02779-59
VISN
21
State
District
VA Office
Veterans Health Administration (VHA)
Report Author
Office of Healthcare Inspections
Report Type
Hotline Healthcare Inspection
Report Topic
COVID-19
Supplies and Equipment
Major Management Challenges
Healthcare Services
Recommendations
2
Questioned Costs
$0
Better Use of Funds
$0
Congressionally Mandated
No

Summary

Summary
The VA Office of Inspector General (OIG) conducted an inspection to assess allegations related to delayed medication delivery from the VA Manila Outpatient Clinic (clinic) pharmacy in Pasay City, Philippines, prior to and during the COVID-19 pandemic. The OIG substantiated a patient experienced medication delivery delays and did not timely receive morphine from the clinic pharmacy in October and November 2019. While the patient requested a renewal in a timely manner, pharmacists could not fill the medication because there was no available stock from the Veterans Health Administration’s (VHA) prime vendor, McKesson Corporation (McKesson). The OIG did not substantiate a second patient experienced medication delivery delays for five new orders, a medication renewal, and a glucometer in November 2019. The OIG was unable to substantiate if this patient experienced delivery delays of three medication refills because the OIG could not determine when the patient requested the refills. Clinic leaders identified a pharmacy processing time of 10.09 days (eight days over VHA and clinic policy requirements) in October 2019. In November 2019, the Chief of Pharmacy Services initiated an action plan. The average pharmacy processing time decreased to 1.63 days in December 2019. The President of the Philippines declared a COVID-19 public health emergency on March 8, 2020, and implemented a quarantine on March 16, 2020, that imposed travel limitations. Four patients experienced medication delivery delays in March and April 2020 due to limited or nonexistent courier transport. The OIG substantiated pharmacists could not dispense insulin to a patient as the clinic pharmacy had no stock after April 2020. McKesson canceled orders for perishable items due to unavailability of flights to the Philippines. The OIG determined that none of these delays resulted in adverse clinical outcomes and made two recommendations related to pharmacy stock shortages and processing delays.

Open Recommendation Image, SquareOpenClosed and Implemented Recommendation Image, CheckmarkClosed-ImplementedNot Implemented Recommendation Image, X character'Closed-Not Implemented
No. 1
Closed and Implemented Recommendation Image, Checkmark
to Veterans Health Administration (VHA)
The VA Manila Outpatient Clinic Manager evaluates the current pharmacy ordering processes and takes action to reduce the frequency of pharmacy stock shortages.
No. 2
Closed and Implemented Recommendation Image, Checkmark
to Veterans Health Administration (VHA)
The VA Manila Outpatient Clinic Manager reviews the impact of nonworking hours, including holidays, on pharmacy processing delays and takes action as necessary.