IV shortage affects Valley

Health services deal with issue during flu season

A nationwide shortage of intravenous solutions has affected Mahoning Valley health services in the midst of a brutal flu season.

"Everyone is (experiencing IV shortages) right now," Mercy Health spokesperson Carrie Kandes said.

The shortage was caused after Hurricane Maria ravaged Puerto Rico, severly damaging its power grid and cutting power to manufacturing plants that produce much of the United States' supply of the solutions.

Supplies of the saline and nutrient solutions used to deliver medicines and treat dehydrated patients were already tight before the hurricane.

Many hospitals are only getting half or two-thirds of what they order and have only a few days' worth of saline on their shelves.

"If we can't support patients coming into emergency rooms who have the flu, more people are going to die," predicts Deborah Pasko, director of medication safety and quality at the American Society of Health System Pharmacists, a professional group. "I see it as a crisis."

The worst shortage is for small saline bags. Hospitals use hundreds or thousands daily to hydrate patients and to dilute antibiotics, painkillers and other drugs, then hang bags from a pole so the mix slowly drips through a tube and into a vein.

Deliveries of those have been most unpredictable, said David Chen, a pharmacy director with Promedica, which operates 13 hospitals in Ohio and Michigan.

"Some facilities are getting virtually zero. Others are having them trickle in. You never know what you're going to get," Chen said.

James Kravec, regional chief clinical officer of Mercy Health - Youngstown, said the shortages have not affected care at Mercy Health's facilities.

"We have enough supply to treat our patients," he said.

Alexa Hall, marketing director for Trumbull Regional Medical Center, said the national shortage has not impacted care there.

Hospital officials, pharmacists and other staff have been devising alternatives and workarounds, training doctors and nurses on new procedures and options and hitting the phones to try to secure fluids from secondary suppliers.

Hospitals have been substituting pills for IV-administered drugs when possible, changing dosing schedules or injecting drugs directly into a vein, what's called IV push.

They've also been changing some procedures, like trying to switch people off IV bags as soon as possible and not starting patients on IV drips during surgery until it's certain they are needed.

Barry Shick, chief pharmacy officer for Mercy Health - Youngstown, said they have substituted other treatment methods when possible.

"Weekly inventory reviews of on-hand solutions and pain medications are assessed and where possible, physicians have been able to substitute oral therapy and solutions to conserve IV bag use," he said.

He added the nearly identical shortage 2014 and 2015 helped to prepare them for this one.

"Communication between health-care providers and manufacturers were instrumental in managing patient care and inventory. Those action plans that were implemented during that shortage are again being utilized," Shick said in a statement.

Baxter International, the owner of the affected factories, and drug distributors took measures to prevent hoarding of the products by health-care companies.

The U.S. Food and Drug Administration has allowed Baxter to import the solution from the United Kingdom, Australia and Ireland, as well as giving two additional companies approval to start selling saline bags

The FDA said last week it believes shortages will start to ease over the next few weeks, but stressed "the production situation in Puerto Rico remains fragile."

Puerto Rico's power grid is at approximately 70 percent capacity, and the last of three Baxter International factories there that make saline bags and nutrient solutions was reconnected just before Christmas. But intermittent power outages are still slowing Baxter's efforts to get back to full production.

Some hospital officials say the severity of shortages stabilized over the holidays, when elective surgeries and other services drop, but others say shortages are worsening.

Erin Fox, who tracks nationwide drug shortages and heads the University of Utah health system's drug information and support services, said its hospital system now has five to eight pharmacists per day working on nothing but managing shortages.

Several noted a cascade effect, with new shortages created as hospitals all try the same workarounds. For instance, syringe supplies are running low because many patients are now getting injections instead of IV drips.

"Everything is hard to get because people are getting whatever they can," said Deborah Sadowski, director of pharmacy services at Deborah Heart and Lung Center, a specialized hospital in southern New Jersey.

Kravec said Mercy Health does not currently have a shortage of any other products.

On the positive side: Hospitals may find ways to permanently reduce use of saline bags. Ohio Health System will evaluate its new practices to see which are cost effective and should be kept, said pharmacy services heard Curt Passafume Jr.

"We should learn something about patient care from this," he said.