By John Leighty
Illustration by Malcolm Garris/PhotoDisc
March 22, 1999

Champagne corks and healthcare jitters will greet the turning of the calendar to Jan. 1, 2000. While partygoers ring in the new century, there’s a good chance that many in the healthcare industry will be taking extra precautions to protect patients from possible side effects of the "millennium bug" and to ensure that they don’t have problems getting the medications they need.

The millennium bug is caused by the inability of computer programs and microprocessors to recognize the year 2000. Most only recognize two-digit date fields (DD/MM/YY), which could make them think the year 2000 is 1900. That will cause many applications to produce erroneous results or even crash unless they are converted to accommodate four-digit date fields (DD/MM/YYYY).

The pharmaceutical industry is spending an estimated $2 billion to make sure equipment and computers are Y2K compliant. But along the medicine pipeline, vendors and distributors are scrambling to resolve problems that could arise if software, transportation systems, and ordering and delivery systems fall victim to the millennium bug.

Y2K could pose a serious threat to the medicine supply, putting millions of Americans at risk, said Laurene West, RN, a consultant with Rx2000 Solutions Institute in Minneapolis. "It’s already too late for the healthcare industry to catch up and fix most of the [Y2K] problems," West said. "The only alternative now is to be sure contingency plans are in effect with nurses and ancillary staff trained and ready to assist in all areas of patient care and safety, including having adequate medicinal supplies. Nurses are going to become very popular."

Stockpiling drugs

West believes healthcare providers should stockpile medications and is pushing for health plans to provide waivers that would allow drug-dependent patients to build up a large supply of prescription medications.

But the major pharmaceutical companies disagree, saying that plan could cause more problems than it solves. The companies are discouraging mass buying by healthcare groups and consumers. "Stockpiling a prescription medicine for any Y2K problem is an unnecessary and possibly harmful action," said Tracy Stenn, a spokesperson for Merck & Co. Inc. "As far as Merck goes, we’ve checked inventory levels for all our medicines and remain confident there will be a continuous supply at the turn of the year."

A rigorous Y2K program begun in 1996 has brought Merck into compliance, and the rest of 1999 will be spent working with other groups in the drug supply chain to ensure they are also bug free, Stenn said. Merck will be monitoring prescription sales, and if an unusually large order is detected, the company plans to contact the customer for an explanation. If unwarranted, the order might be denied, Stenn said.

Discouraging panic

Pharmacists across the country are being asked to discourage customers from panic buying, said Susan Winckler, RPh, director of policy and legislation for the American Pharmaceutical Association. Any movement toward stockpiling drugs could cause more chaos than the Y2K problem itself, Winckler said. "There’s been suggestions that [consumer advocates] build up a supply of the top drugs. But there may not be a run on top 100 drugs. Let’s say a patient advocacy group decides to stockpile for attention deficit disorder, then there could be a run on the 410th most-used drug."

What happens in these cases is that certain medicines will be plentiful in some areas and scarce in others, which could present life-threatening situations, Winckler said.

But there’s no way of knowing what will actually happen on Jan. 1, 2000. Joel Ackerman, executive director of the Rx2000 Solutions Institute, said while it’s true U.S. pharmaceutical companies are ahead of the rest of the world in fixing Y2K, 80 percent of their raw materials come from other countries that aren’t as far along. "There’s been no end-to-end testing of the supply chain to assure us that it will be OK," Ackerman said.

Prepared for anything

Preparation is the key to dealing with Y2K, said Sarah Raphel, RN, director of the American Nurses Association (ANA) Department of Nursing Practice. Within medical facilities nurses should be able to work with pharmacists in ensuring medicines are dispensed and administered properly, even if the lights go out, she said. The ANA is a member of the National Patient Safety Partnership, a coalition of organizations working to ensure patient safety. The partnership is working on a range of Y2K issues, including making sure there are no disruptions along the medicine supply line. "We want to make sure medications, equipment, and devices are all safe and secure," Raphel said.

Contingency planning is crucial at the nurse-patient level, said Rose Mary Carroll-Johnson, MN, RN, editor of Oncology Nursing Forum, the official journal of the Oncology Nursing Society. Because cancer patients receive many drugs based on protocols with dosages calculated by computers, nurses must know what the appropriate medicines and scheduling procedures are, as well as how to manually track such things as cumulative doses, she said.

Nurses need to ask themselves whether they have the skills to manage without a computer and whether they know how to double-check whether a computer is giving correct information, Carroll-Johnson said. "It could get very complicated. Many nurses have grown up with the technology. And I honestly don’t know if they have the skills to manage without it."

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xxRelated Sitesxx American Nurses Association

Government web site for y2k information

American Red Cross
y2k information

Rx2000 Institute
A clearinghouse for y2k issues in healthcare

American Hospital Association