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

Problem definition: Despite their frequency, there is scant research studying how substitutions in response to pharmaceutical supply chain disruptions impact medication errors in hospitals. To address this gap, we study this causal relationship using a natural experiment: hurricane damage to factories that produce heparin, an important drug used frequently in hospitals.Methodology/results: We collect data on medication errors from U.S. Food and Drug Administration’s Adverse Event Reporting System and we gather drug sales data from IQVIA’s National Sales Perspective™. Applying the synthetic control method, we find that the hurricane-related pharmaceutical supply chain disruption increased heparin medication error rates by about 152%. In addition, we find significant spillover effects. The supply chain disruption increased medication error rates of a substitute drug, Enoxaparin, by about 114%. Implications: Our study shows that prophylaxis measures assumed to be effective, such as substituting medications, may be unsafe. Our paper contributes to the supply chain management literature by empirically linking the effects of supply chain disruptions on downstream errors. Additionally, this paper complements medical literature studying the impact of drug shortages on medication errors by providing a rigorous causal estimate. Finally, we discuss several measures hospital managers can implement to prevent medication errors during a disruption of drug supply