Operational Workflows and Decision Making Processes in Hospital Pharmacy Services During Drug Shortages: A Scoping Review

Background: Drug shortages significantly impact hospital pharmacy services, patient care, and operational efficiency. Although causes and prevalence are well documented, evidence on operational workflows and decision making processes in shortage management remains fragmented. Objective: This scoping review aimed to characterise the profile of drug shortages and map the operational workflow processes and decision making pathways used by hospital pharmacy personnel to manage drug shortages, including operational strategies, communication practices, and policy implementation. Methods: Eligible sources included primary empirical research, conference papers, conference abstracts or proceedings with sufficient methodological detail, and dissertations with accessible full text empirical findings involving hospital pharmacy settings. Only English language studies were included. Ovid MEDLINE, Scopus and Web of Science were searched from database inception to 23 February 2026. Extracted data included study characteristics, healthcare setting, shortage type, operational workflow processes, decision pathways, communication strategies and guiding policies. Results: Of 1053 records identified, 31 studies were included, predominantly from high income settings. Drug shortages commonly involved essential and injectable medicines and were associated with treatment delays and service disruption. Causes were multifactorial, including manufacturing failures, supply chain inefficiencies, economic constraints and external shocks. Management activities were synthesised into three interconnected phases: (1) detection and assessment, (2) response and strategies and (3) mitigation and evaluation. Key strategies included procurement optimisation, inventory control, therapeutic substitution, allocation prioritisation and interfacility redistribution, supported by communication systems. Conclusions: Drug shortage management is a complex process that extends beyond inventory control and requires coordinated clinical, operational and governance responses. The proposed workflow framework provides a structured but adaptable representation of the shortage management process that may inform responses across different healthcare settings. Future studies should evaluate the feasibility and applicability of the framework across diverse settings and examine the potential role of predictive analytics and inventory management supported by artificial intelligence (AI) in strengthening early warning capabilities and preparedness.