6. Duke has an advantage in that it has a compounding pharmacy which enables the organization to formulate drugs that are in short supply, but using them quickly in patients being cared for by Duke's healthcare system may mean foregoing sterility testing. Patients who receive such drugs must sign consent.
7. An ironclad rule prohibits purchasing medications from "gray market" vendors "because we can not assure a proper chain of custody or the integrity of the medication, although using these medications could give the appearance of lessening the gravity of the shortage."
8. Prohibit use of drugs deemed to be in short supply in research studies.
9. Take a weekly inventory of 20 unique oncology agents and a daily inventory of 70 to 100 non-oncology drugs that could be in short supply.
10. When a drug is scarce, patients may be asked to receive the drug on the same day "to minimize wastage from single-use vials" through safe practices.