Discourse, Dissonance, and Dualities: How Drug Shortages Are Understood and Communicated Among Health Care Professionals.

Persistent drug shortages introduce challenges to clinicians and health care systems. We describe an exploratory qualitative study of key informants' perspectives, discourse, and experiences in confronting drug shortages. Semi-structured interviews were conducted with pharmacy directors and bedside clinicians at urban academic medical centers and surrounding community hospitals. Focused coding, reflexive review, and thematic analyses informed by constructionist grounded theory were employed. For some participants, the unpredictability of drug shortages created a siege mentality. Recognition of potentially related patient safety deficits also led to moral distress. Participants were often unprepared to make explicit allocation decisions nor openly discuss drug substitutions with patients. Despite these struggles; participants displayed resilience, and inter-professional teamwork, which eclipsed role constraints and medical hierarchical authority. Varied perspectives and responses are described.