Anesthesia Management: Hospitals deal with IV supply shortage

The problem may not be resolved until the end of 2014 or beginning of 2015

Back in January, U.S. hospitals began to experience a serious shortage of intravenous saline solutions, caused mainly by a spike in demand during the beginning of the 2013 flu season. Fast forward to May, and hospitals are still struggling with the shortage.

All three manufacturers of IV saline — Baxter International, Hospira, and B. Braun Medical — are working to address the shortage and, as a result, are not currently able to take on any new customers.

According to Scott Crandall, senior director of surgical and anesthesia sourcing operations at Novation, a healthcaresupply chain, analytics and contracting company, the U.S. Food and Drug Administration (FDA) has been attempting to ensure that adequate amounts of IV saline are reaching hospitals, including allowing the import of supplies from Norway and Spain. However, he doesn’t see an immediate end in sight to the shortage. Crandall said the problem may not be resolved until the end of 2014 or beginning of 2015.

Hospitals are being advised by the FDA to use oral hydration as much as possible instead of saline, or to use smaller IV bags, at least while they last, along with more frequent bag changes.

“We’ve been in constant contact with the hospitals we contract with and I’ve been asking them whether the shortage has eased at all,” Crandall said. “The immediate response was along the lines of, ‘until I have to stop spending time on a daily basis managing our allocated supply, it’s still a major headache for us that creates a lot of problems.’ Ultimately, this shortage affects patient care. It’s standard practice to keep patients hydrated using IV saline. Now hospitals have patients drink more water when possible. Hospitals have had to alter their clinical protocols. Some have even cancelled some elective procedures due to the lack of IV saline.”

Erin Fox, director of Drug Information Service at University of Utah Health Care, explained that while she hasn’t heard recently of any hospitals on the verge of running out of IV saline, like many were in January, hospitals have had to make a number of changes in order to conserve their supplies. She said management of the shortage has been an “extraordinarily disruptive process to both pharmacy operations and general hospital supply chains. It’s not only a medicine, but a supply, and it’s always been stocked in every nook and cranny of a hospital.”

Fox said her health system has had to change the way it uses IV saline products, including the very bags in which it’s prepared. Baxter International is also short on those as well, she revealed.

“We’ve had to change the way our pumps work, the information in our electronic medical records and other computer systems, and we’ve had to have extensive communications with our nurses about it,” Fox said. “When you’re not getting something you’ve always been used to having, it creates a tremendous amount of work in order to minimize the impact on patients. At the end of the day, we’ve put in many extra hours of work, jumping through hoops in order to make this change invisible to patients. It’s our job as providers to minimize the impact on patients.”