Working around supplier allocations has become a regular part of the job for pharmacists in hospitals and there’s no end in sight to the fluids shortage
As flu season looms, materials management and pharmacy teams are anxiously watching their IV fluid supplies. Despite hopes that the months-long saline solution shortage would clear up over the summer, the situation has not improved and there are indications that it has worsened.
“The saline shortage has not resolved, and has actually expanded into other IV solutions, including lactated ringers solution, which is almost universally used during surgical procedures,” says David Jaspan, RPh, director of pharmacy and materials management at Union Hospital of Cecil County in Elkton, MD. He estimates that three out of every four patients require IV solutions of some sort during their hospital stay.
“Additionally, we have recently seen that sterile irrigation solutions, also used in surgical procedures, have been affected,” Jaspan says. “Today, we ran out of available saline solution. We get our delivery of saline and other IV fluids on Thursday, and today is Tuesday. When this happens, we have to find alternatives.”
Finding alternatives has become a typical part of Jaspan’s week. Toward the end of the week, “we find ourselves struggling to manage with what we have. We ask physicians to use different IV solutions. Often we compound dextrose and half normal solution in our pharmacy,” he explains.
“It’s been a very challenging market,” agrees Ron Hartmann, senior vice president of pharmacy with MedAssets, a healthcare performance improvement consultancy. “Things started to get tight toward the end of last year. It really has persisted throughout the year.”
It’s not just saline solution that’s in short supply. Hartmann says peritoneal dialysis solution is also scarce—which means some organizations have to perform kidney dialysis with other irrigation solutions, exacerbating spot shortages of versatile solutions.
He notes that the three US manufacturers of IV fluids, BBraun,Hospira and Baxter all have their existing clients on allocation. Union hospital has been put on an allocation by its IV supplier. It “provides us only about 50% of our normal monthly utilization,” says Jaspan.
“Every IV fluid manufacturer has their fluids on allocation. That’s been ongoing since the first quarter of the year,” confirms Gary Freeman, vice president of pharmacy at Amerinet, a group purchasing organization. Asked how many hospitals are affected by the shortage, he replied, “all of them.”
Increased Demand, Increased Costs
“Our former supplier wanted to give us a $200,000 price increase yearly for saline solution alone. That’s for a 125-bed hospital. It would have been 300% increase in price,” says Jaspan. His hospital opted to switch to a different supplier, which allowed the hospital to maintain its costs close to previous levels.
But many organizations have not been so lucky.
While Hartmann says the typical price increase for IV fluids is between 40% and 50%, some hospitals and healthcare systems are paying double what they used to for saline. Additionally, manufacturers have been turning away new customers, leaving them at the mercy of their current supplier.
“People should be aware of that if they are interested in exploring options, the current dynamics may not support it,” he says.
While the FDA maintains that the shortages should end in the first quarter of 2015, few veteran clinicians are confident that is the case, especially since the FDA’s permission to import saline from European manufacturers will expire at the end of December, and there continue to be setbacks in fluid production stateside.
“[Sterile irrigation products] are starting to go into shortage,” says Freeman. “There was a recall… in the last couple weeks which has affected the irrigation solutions…. these shortages could get very bad during the winter—that’s when this all started…. I don’t foresee the allocation changing any time soon.”
“Now,” he says, “people are gearing up for the coming winter and flu season. But I can’t say people are stocking up, because there isn’t much to stock up with.”
Jaspan shares Freeman’s concern. “The continuation of allocation means we are running out of IV solutions at the end of each week, every week. Each week, the end of the week will get more difficult—until this constant limit of available product ends,” he says.