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November 29, 2017
Wash. hospitals experiencing IV bag shortage after hurricanes
By Molly Rosbach
YAKIMA, Wash. — When Hurricane Maria decimated Puerto Rico two months ago, it also wreaked havoc on the island's major drug manufacturers, and Yakima hospitals are feeling the crunch.
The hurricane's destruction and the island's ongoing lack of electricity have led to a shortage of bags of IV (intravenous) drugs used in the U.S., including some of the most common simple solutions hospitals need for day-to-day care, as well as opiate painkillers.
For local hospitals, that has meant a 75 percent cut in normal supply of some items.
At Virginia Mason Memorial hospital, "Just our (operating room) goes through 12 cases a day of lactated Ringer's," a solution used to replenish fluids and electrolytes in patients going through surgery or childbirth, said Chris Cook, the hospital's pharmacy operations manager. Each case has 12 IV bags in it.
Also in short supply is saline, or sodium chloride, the solution most frequently given to help rehydrate patients. The liquid is essentially what blood is made of, if you take out all the blood cells, Cook explained.
Saline and lactated Ringer's are also commonly used to dilute and deliver medications intravenously.
"In the last few weeks, our replenishment has probably been closer to 25 percent of what we typically would order," Cook said.
At Astria Regional Medical Center and Astria Toppenish Hospital, the pharmacies also are currently receiving only 25 percent of normal supply of IV mini-bags from the manufacturer, director of Materials Management Brian Fischer said.
The mini-bags contain either 50 mL or 100 mL of saline.
"The cost of the IV mini bags has not increased because we are on contract with the supplier, but our shipping costs have increased because we are sourcing from other places," Fischer said.
Manufacturers have stepped up production at facilities outside of Puerto Rico; some are now shipping IV bags from Europe.
Hospitals are doing everything they can to conserve the existing supply and limit the impact on patients.
"Some medications can be administered without the use of the IV mini bag. Where we may have used a bag for convenience we can administer some medications via syringe. We also can use a syringe pump when needed," said Toppenish's pharmacy director Patrick O'Connor.
He noted that Toppenish's lower patient volume means the IV bag shortage has had a smaller impact there.
Memorial also has been looking to limit unnecessary IV bag use.
"Oftentimes, we'll have things on hand and readily available for 'emergency' that ends up going to waste, so we just want to decrease some of those," Cook said.
Hospital pharmacies can manufacture some sterile solutions in-house, using sterilized water and concentrated electrolytes. And medications can be diluted using other solutions besides saline or Ringer's.
Among damage done to other medication manufacturing, the hit to IV opiates is probably the biggest problem, Cook said.
"We can't hydrate you and then we can't treat your pain," he said, summing up the status of the shortages.
Most oral painkillers are readily available, Cook said. But IV painkillers are used during surgery, immediately after surgery, in the emergency department, and for cancer and hospice patients.
But the hospital's pharmacy department is working to use alternate opiates, and the shortage will actually help encourage physicians to be better stewards in their use of painkillers, Cook said, so people don't receive unnecessary opiates.
Around the Valley, pharmacy departments are finding ways to make it work.
"Pharmacy plays an important role during this shortage by finding alternative ways of delivering medications to our patients," said Astria Sunnyside Hospital pharmacy director Andre Gouws. "We don't know what the long term (holds) but so far we are able to manage."