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HAP Hosts Webinar about IV Fluids and Medication Shortages

November 20, 2017

The Hospital and Healthsystem Association of Pennsylvania (HAP) recently hosted a webinar, “Insights for Medical Considerations in Management of the Growing IV and Medication Shortage." The webinar was held in response to the shortages of IV fluids, particularly small volume solutions. Saline IV fluids are used to inject drugs intravenously in hospital and outpatient settings.

Hospitals across the country have reported shortages on and off since 2014. The recent hurricane in Puerto Rico has significantly interrupted production and distribution of saline from more than 40 plants.

HAP’s webinar included a presentation from Penn State Hershey Medical Center leaders about best practices to conserve IV fluids, use alternative medication administration, and educate care health care teams. Among the issues addressed:

  • Use of oral hydration
  • Use of smallest bag appropriate
  • Use of syringe pumps to replace mini bags
  • Increased administration by IV push vs infusion bag when appropriate (Use detailed charts to provide guidance)
  • Use of “stop sign” poster on all nursing units to reinforce practices
  • Fluid changes only when bag is depleted
  • Coordinating fluid needs with Anesthesia

Thomas Grace, HAP’s vice president, emergency preparedness, provided a summary of the current U.S. Food and Drug Administration situational report.

Among the steps the FDA is taking in conjunction with manufacturers of these products:

  • Temporarily allowing the importation of IV saline products from facilities outside of the U.S.
  • Encouraging the expansion of production at existing facilities to meet shortfalls
  • Expediting our review of new product applications that will help address this shortage

In addition, the FDA released Small-Volume Parenteral Solutions Shortages, which provides guidance to help health care professionals manage the shortage. The information covers:

  • Clinician conservation guidance
  • Inventory control strategies
  • Pharmacy operations strategies
  • Infusion pump practices and protocols
  • Safety practices

During late October, the state Department of Health, with direction from the Bureau of Emergency Medical Services, issued EMS Bulletin 2017–19, about potential sterile saline solution shortages. Guidance for EMS personnel included:

  • Limit intravenous (IV) access to situations where statewide Advanced Life Support protocols specifically require IV access or fluids
  • Use saline locks rather than bags of infused saline when IV access is needed for possible medication administration without the immediate need for the patient to receive fluid volumes
  • Consider using bags of saline only when a patient is hypotensive and requires volume replacement

HAP’s emergency preparedness team has been working with member organizations and DOH to assess regional shortages, and will continue to do so. Hospitals are closely monitoring the shortage and implementing appropriate protocols and practices. For more information, or to learn how to access a replay of the webinar, contact Tom Grace, HAP’s vice president, emergency preparedness.

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