Following the hurricanes in Puerto Rico and Texas, the healthcare industry is facing an acute shortage of IV bags. Baxter, one of two manufacturers of the bags was forced to shut down its plants in Puerto Rico, with no clear date for reopening.
The IV bags contained both saline and dextrose solutions. Administering saline solution is the primary way to rehydrate patients and keep their blood volumes up. Dextrose solutions are also used to maintain blood volume and to increase patient blood sugar, which at times can be critically low.
Both solutions are also used to deliver diluted drugs which shouldn’t be given in their concentrated forms. Additionally, the solutions are used for drugs that need to be delivered over time in an infusion. In particular, this method is used for administration of cardiovascular drugs which can keep patients’ hearts pumping. One of the frustrations for hospitals and the Food and Drug Administration is that drug manufacturers often fail to communicate the reasons for shortages, leaving pharmacists in the position of not being able to tell prescribers why the drug they need is in short supply or why it requires an alternative.
While some of the causes of drug shortages come from the manufacturing and supply side, other factors have coalesced to increase the frequency of shortages. Since the implementation of the ACA, quality assurance standards have become more stringent, which has led to some smaller manufacturers closing because they are not able to meet those standards. This a positive from an overall quality and safety perspective, but the industry has not yet adjusted to the increased consolidation of drug manufacturers.
With the closing of the Baxter plant, the pressure is on Pfizer, the other major manufacturer of IV bags, to meet the demand of the nation’s hospitals. Of course, it is impossible for them to immediately increase their supply to match demand, so they’ve had to allocate—or ration—the bags.
Hospitals are allocated a certain number of bags based upon their previous purchase histories. However, for companies that have no history with Pfizer, they may be allocated less bags than will adequately fulfill their needs. In that case, a hospital can rely on internal measures, such as strategic distribution of available bags throughout facilities. Another option is to reach out to neighboring facilities that may lend solutions to get a hospital through a tough patch.
An important resource to help manage shortages is a weekly publication from the American Society of Health-System Pharmacists (ASHP), which makes hospitals aware of current and potential shortages. The ASHP also provides a website that continuously tracks the status of shortages, when the may resolve, and available alternatives to the shorted drugs.
Standardized practices may be the key to managing drug shortages internally. To that end, ASHP drafted a three-phase approach to drug shortages: identification and assessment phase, preparation phase, and contingency phase.
Identification and assessment involves acquiring information about the details and duration of the shortage—when available, measuring on-hand inventory, and assessing the threat to patient care and costs. The preparation phase includes assessing therapeutic alternatives, prioritizing patient safety, looking at external relationships with other health systems, and practicing restraint in drug stockpiling. Finally, the contingency phases focuses on risk management and liability, budget considerations, and information coordination and communication.
Being cognizant of the available resources and mitigation strategies can contribute to a successful drug shortage response, and understanding the sources of drug shortages can help guide strategies to minimize future occurrences.
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