HIRC: “High level” of provider concern over IV solutions supply

HIRC member sentiment in early October suggested a high level of provider concern, an expectation of 4-6 months for recovery, and constrained alternative sources.

“My opinion is that the recovery time frame will exceed existing inventory if demand remains unchanged,” Schafer said. “Users of all IV fluids must conserve. Less use by all means more product for the patients that need it most.”

“In my experience, Baxter has been transparent and forthcoming,” said Schafer. “At the same time, the situation is serious and hospitals must activate their incident response teams and conservation measures.”

B Braun, another leading IV fluids supplier, is manufacturing 24/7 to help meet the need. Other alternative suppliers include Fresenius Kabi and ICU Medical.

A majority of surveyed providers indicated stockpiling. “This is instinctive and understandable,” Schafer said. “However, any excess in the form of hoarding will only exacerbate anticipated shortages.”

Hospitals will likely need to implement firm conservation strategies and alternate therapies where possible. “Unfortunately, this is not a new experience where nature struck the IV fluids market,” Schafer said. “As such, most hospitals have existing plans and experience.”

Schafer said one-third of surveyed provider members have already implemented conservation strategies. “In my opinion, all providers should be doing this now to reduce the risk of future shortages.”

Some of the most common mitigation strategies included:

General:

• Deliver IV fluid based on patient need
• Regularly assess patients receiving IV infusions
• Consider clinical alternatives (e.g. IV push, intramuscular, subcutaneous or intra nasal doses)
• Convert all possible medications from IV to oral (PO) form
• Use premixed antimicrobials, if available
• Limit utilization of parenteral nutrition (PN)
• Use the smallest possible indicated volume
• Use smaller bag sizes for slower rate infusions where practical
• Use sterile water vials or saline vials for reconstituting IV medicines instead of using large volume fluid bags
• Do not use IV fluids for non-IV administration
• Avoid practice changes that require additional fluids
• Avoid spiking bags or opening overwrap until you are certain that IV fluid will be administered

Surgical

• Minimize fasting to reduce need for fluid replacement
• Avoid priming of IV giving sets until certain of IV fluid requirements

Pharmacy

• Consider premixed and ready to use IV products
• Leverage 503B sources when available

Supply Chain

• Ensure backorders are registered and allocations are filled
• Explore all alternative sources to maximize inventory
• Consider signage at point of use to alert clinicians for the supply disruption

Hospital leaders can prioritize mitigation efforts to ensure minimal disruption to patient care through frequent cross-functional communication internal and external, patient-centric conservation strategies, and maximizing available inventories without hoarding. “Stand up a cross-functional response team that bridges clinicians, pharmacy, and supply chain,” Schafer said. Near real-time analytics and periodic status updates to inform decision makers will be important, as will opening all available communication channels.

Hospitals and health systems can use this as an opportunity to strengthen their supply chain resilience by prioritizing resiliency in their sourcing decisions,” Schafer said. “Consider implementing the HIRC resiliency badging program as a specific strategy to measure and elevate resiliency in sourcing strategy. This program rigorously assesses supplier operational and resiliency maturity. Suppliers with this badge have proven the capacity to more often predict, resist, and recover from disruption. We encourage all strategic suppliers to pursue this badge and for all providers to inquire if their trading partners have this designation. Having a badge does not eliminate disruption. Disruptions are inevitable, which is why resilient partnerships are key.”