HOSPITALS
patient-by-patient basis and using different ways to deliver drugs, such as pushing them into an IV line with a syringe or switching to oral or skin-injected medications. Available bags are reserved for the most critically ill or for patients for whom there are no other viable options.
“We have gone into aggressive shortage-management mode,” said Curt Passafume Jr., OhioHealth’s system vice president for pharmacy services. “I’ve never seen anything like this before. It’s challenging us to think differently than we thought in the past, because we have to.”
All of central Ohio’s hospital systems have been affected by the shortage, as have Nationwide Children’s Hospital and the Chalmers P. Wylie VA Ambulatory Care Center.
With some sizes of bags in higher demand than others, some providers have taken to using different sizes or transferring saline from large bags into smaller, empty bags that are easier to obtain. Others are preparing medications themselves instead of using pre-bagged versions mixed with saline.
The changes are having an impact.
About 11,000 bags of either 50 ml or 100 ml were used in the month ending Jan. 16 at seven of OhioHealth’s hospitals. That’s about 27 percent less than the roughly 15,000 that were used last July, before the hurricanes hit.
At Mount Carmel Health, chief pharmacy officer Janet Whittey estimated that changes throughout the system have reduced the number of IV bags used for patient care by about 25 percent.
“We’ve been able to maintain the care of our patients in our usual way. We’re just having to do things a little differently,” Whittey said.
While hospital systems have been dealing with the most acute shortage since the fall, IV bag supplies have been an issue since 2013, Passafume said.
“The hurricane devastation in Puerto Rico was just a final straw in a challenging situation,” Whittey added.
Dr. Scott Gottlieb, commissioner of the federal Food and Drug Administration, provided an update on the matter this past week, saying the problem has been exacerbated by this year’s worse-than-usual flu season.
He said the FDA is working to ensure that Puerto Rico facilities can operate at full capacity, asking manufacturers to import products from foreign factories and approving IV saline products from additional companies. The agency also is considering extending the expiration dates on some products.
For years, the standard of care has been to insert an IV line, connected to a salinefilled bag, into the arm of most patients who enter hospitals, Passafume said. But the shortage has forced practitioners to turn to methods that may have been more common in the 1990s, changes that have required quick education and training of nurses, physicians and pharmacists.
Some of the changes have proved more efficient and economical and could continue even after the shortage crisis ends, he said.
“We’re having to get more innovative in the way we deliver care as opposed to automatically doing the same things we always did every day,” Passafume said. “We’re going to learn a lot
about patient care.”
While the IV bag shortage has gained much attention because of its link to the Puerto Rico hurricanes, health officials say the problem is just one example of the deficits they manage on a regular basis.
Other hurricane-related shortages include certain antibiotics and IV-delivered nutrition, said Crystal Tubbs, associate director of the pharmacy department at Ohio State University Wexner Medical Center. Additional shortages include pain medications and electrolyte fluids, said Dr. Andrew Thomas, Wexner’s chief medical officer.
In all, there are nearly 150 items on a national drugshortage list and 250 to 275 items that Wexner employees are keeping an eye on, Tubbs said.
The shortfalls can be caused by a lack of adequate raw materials, factory shutdowns, recalls or decisions by manufacturers to stop producing certain products, she said. And often, there’s a “trickle-down effect,” with lack of one product leading to more reliance on another product that then becomes difficult to obtain.
When difficulties arise, hospitals might turn to different suppliers, switch to new equipment or seek alternative medications that will be as effective as the ones in short supply. They must prioritize, using scarce items for patients who have no alternative.
“Some diseases can only be treated by one medication,” Thomas said. “We really try to make sure we preserve the limited supply of any medication we have left so that certain subsets of patients who need that medication have it.”