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IV fluid shortage at Billings hospitals beginning to ease

February 15, 2018 GMT

Billings Clinic has seen an easing of the shortage of IV saline solution that hit hospitals around the United States beginning last fall.

“We’re seeing our allocation and delivery consistently coming,” said Erik Wood, vice president of ancillary services for the Billings hospital. “It’s a sign we think we’re through the most challenging part.”

The Food and Drug Administration released an update Jan. 16 that agreed with Wood’s assessment.

“Based on the information we’re receiving from companies and the actions we’ve taken at FDA, we continue to expect that the shortage of IV fluids will improve in the coming weeks and months,” FDA Commissioner Scott Gottlieb said in a written statement.

Angela Douglas, communications manager for SCL Health Montana, which includes St. Vincent Healthcare, added that the health system’s supplier reported it is up to full production capacity.

“We are beginning to see signs that the shortage is easing and will be fully resolved by the end of the first quarter,” Douglas said in a written statement.

Hospitals use IV saline solution, which comes in many different sizes, for many different purposes. Larger bags often are employed to help dehydrated patients, while the smaller bags are used to administer medications.

The shortage began to impact Billings Clinic in the first part of October. The hospital had already prepared for the fact that B Braun Medical Inc., its main supplier, had scheduled a temporary shutdown for maintenance at a production facility.

“Then Hurricane Maria hit Puerto Rico and knocked out Baxter Healthcare,” which has a production plant in Puerto Rico for smaller 50- and 100-milliliter IV bags, Wood said.

The Sept. 20 disaster left one main supplier, Hospira/ICU Medical, to provide IV solution. So Billings Clinic tackled the problem in a couple of ways.

“We did our best to identify where we could purchase from and make sure we had explored and turned over every rock to make sure we had enough IV fluid available,” Wood said.

And second, the hospital developed a multidisciplinary team to look at strategies to handle the shortage, while “maintaining high quality care.” It brought together representatives from its pharmacy, nursing, physician and administrative staffs to brainstorm ideas.

“When we looked at overall utilization, we took a snapshot in time that included flu season, which is our highest demand level, and how we were going to manage with less going into that,” Wood said.

One approach it took was to encourage patients to drink fluids, whether in the hospital or at home before surgery. And then, instead of infusing medications through IVs, they were given to patients using a handheld syringe.

“It’s a different practice but the same outcome,” he said.

That and other conservation measures let the hospital go from using an average of 17,000 units (bags) of solution per month to 11,000 units. The conservation effort allowed the hospital to share IV fluids with several of its regional partners.

The downside was while overall use decreased, the cost to buy the IV fluid went up.

“You are paying a premium when there’s a reduced amount of supply,” Wood said.

While flu season continues the hospital will keep a close eye on the supply to make sure enough IV saline is available for patients. The team is also evaluating the changes that were made, deciding what to carry into the future and what to discard.

For instance, infusing medication through an IV is a best practice. It also frees up the medical staff to focus on other patient-related duties and “that’s what we want to optimize.”

As much as anything, the hospital learned the value of using a multidisciplinary team to solve a critical problem.

“If we’ve learned anything in this, it’s the value of that,” Wood said.