Health system strategies to mitigate the IV shortage

 Hospitals and health systems nationwide are implementing conservation strategies and exploring alternatives to address the national shortage of IV fluids. 

Hurricane Helene significantly damaged a Baxter plant Sept. 30 in Marion, N.C.,that makes 60% of the nation's IV fluid products. The company said it anticipates it will be able to bring supply allocations back up to 90% to 100% levels by the end of the year, with nationwide supply disruptions likely to linger until then, according to an Oct. 9 press release from the company.

Amid the disruptions, healthcare organizations nationwide are already facing constrained IV fluid supplies, spurring operational challenges and care delays. Around 75% of organizations have either paused non-emergency surgeries or are considering the option in the near term, according to an Oct. 9 survey from Premier. 

The American Hospital Association and American Society of Health System Pharmacists have called for emergency actions to address the crisis, urging federal agencies to facilitate the temporary import of IV fluids from abroad. Meanwhile, the FDA is actively working to expedite the review process of these imports. 

Conservation strategies 

As hospitals await federal interventions, many are actively implementing conservation strategies to mitigate effects on patient care. 

Durham, N.C.-based Duke Health has implemented a 24/7 incident command center to manage IV inventory and usage across its health system. 

"We have launched several phases of conservation strategies to decrease daily consumption where it is safe to do so," said Mary Martin, COO of Duke University Hospital. This initiative includes temporarily rescheduling elective procedures that require high liquid IV volumes. Notably, Ms. Martin said Duke is actively exploring alternative fluid options for complex surgeries and urgent treatments, like dialysis and ECMO, which can't be delayed. 

"We have some very complicated surgeries in urology that use several liters of saline and we are looking at alternative fluid options for these procedures," said Ms. Martin. Additionally, Duke is having ongoing discussions about supply strategies with the Board of Pharmacy and the Duke Chemistry Department. 

Somerville, Mass.-based Mass General Brigham hospital has been prioritizing patient needs, using alternative methods to conserve. 

The hospital, which consumes more than 100,000 liters of IV fluid each month is giving patients who are healthy enough Gatorade or water instead of IVs and has also temporarily halted the practice of discarding IV units and replacing them with new units when patients are transferred. 

Duke Health is also collaborating with its medical directors to review over 140 order sets related to IV fluid needs. 

While Duke Health has been implementing some conservation strategies, Ms. Martin urges immediate intervention from the federal government to free up or increase the supply of critical IV fluids. One intervention, she said, would be to have EUA authorization for manufacturing plants outside the U.S. 

"I would like to add this is a particularly challenging time for Duke and we have deployed staff members to the command and temporary medical facilities in the hurricane ravaged areas of western North Carolina as well as to Duke LifePoint Hospitals," Ms. Martin. 

In response to the crisis, other physicians have also implemented some emergency mitigation strategies. Michael Apostolakos, MD, chief medical officer and vice president of New York-based University Rochester Medical Center, highlighted the importance of using alternative fluids for emergency reasons, stating, "We are exploring all opportunities with alternative suppliers." 

Currently, the Baxter facility is responsible for 1.5 million bags of IV solutions daily, essential for emergency departments, operating rooms and ambulances. 

Vizient, a healthcare improvement and group purchasing organization, has been working on providing resources for other health systems. For example, the organization created a product impact brief that provides up-to-date market information and resources for implementing alternative therapy protocols. The organization also has an IV push list that provides the specific information for reconstitution, dilution and administration of select medications via IV push. 

Mittal Sutaria, PharmD, senior vice president of contract and pharmacy services for Vizient, said the organization supports increasing production from current suppliers and encourages the FDA to explore rapid supply, including potential imports. 

"Currently providers are utilizing conservation strategies as a top priority to ensure uninterrupted care to their patients," Dr. Sutaria said. "They continue to prioritize the most critical patients and utilize alternative therapy protocols where clinically appropriate." 

https://www.beckershospitalreview.com/supply-chain/health-system-strategies-to-mitigate-the-iv-shortage-what-to-know.html