Months after Hurricanes Irma and Maria damaged Puerto Rican plants that manufacture saline-filled IV bags, some hospitals in Ohio are still dealing with a shortage of the bags routinely used to deliver medication, nutrition and hydration to patients.
Locally, Angie Long, vice president of Clinical Services at Southeastern Ohio Regional Medical Center, said there hasn’t been any major issue locally.
"The hospital has been impacted due to the IV fluid shortage, but not to any great extent where we’ve had to impact patient care," Long said.
"For a period the last couple weeks we were breaking down large volume bags into smaller volumes using empty bags in order to compound a few of our IV piggybacks.
"Speaking with Jim Starr with United Ambulance, he indicated they have not been impacted in any way with the shortage of IV fluids."
Health care providers are reviewing whether such bags are a must-have on a patient-by-patient basis and using different ways to deliver drugs, such as pushing them into an IV line with a syringe or switching to oral or skin-injected medications. Available bags are reserved for the most critically ill or for patients for whom there are no other viable options.
"We have gone into aggressive shortage-management mode," said Curt Passafume Jr., OhioHealth’s system vice president for pharmacy services. "I’ve never seen anything like this before. It’s challenging us to think differently than we thought in the past, because we have to."
All of central Ohio’s hospital systems have been affected by the shortage, as have Nationwide Children’s Hospital and the Chalmers P. Wylie VA Ambulatory Care Center.
With some sizes of bags in higher demand than others, some providers have taken to using different sizes or transferring saline from large bags into smaller, empty bags that are easier to obtain. Others are preparing medications themselves instead of using pre-bagged versions mixed with saline.
The changes are having an impact.
About 11,000 bags of either 50 ml or 100 ml were used in the month ending Jan. 16 at seven of OhioHealth’s hospitals. That’s about 27 percent less than the roughly 15,000 that were used last July, before the hurricanes hit.
At Mount Carmel Health, chief pharmacy officer Janet Whittey estimated that changes throughout the system have reduced the number of IV bags used for patient care by about 25 percent.
"We’ve been able to maintain the care of our patients in our usual way, we’re just having to do things a little differently," Whittey said.
While hospital systems have been dealing with the most acute shortage since the fall, IV bag supplies have been an issue since 2013, Passafume said.
"The hurricane devastation in Puerto Rico was just a final straw in a challenging situation," Whittey added.
Dr. Scott Gottlieb, commissioner of the federal Food and Drug Administration, provided an update on the matter this week, saying that the problem has been exacerbated by this year’s worse-than-typical flu season.
He said the FDA is working to ensure that Puerto Rico facilities can operate at full capacity, asking manufacturers to import products from foreign factories and approving IV saline products from additional companies. The agency also is considering extending the expiration dates on some products.
For years, the standard of care has been to insert an IV line, connected to a saline-filled bag, into the arm of most patients who enter hospitals.
But the shortage has forced practitioners to turn to methods that may have been more common in the 1990s, changes that have required quick education and training of nurses, physicians and pharmacists.
Some of the changes have proved more efficient and cost-effective and could continue even after the shortage crisis ends, he said.
"We’re having to get more innovative in the way we deliver care as opposed to automatically doing the same things we always did every day," Passafume said. "We’re going to learn a lot about patient care."
While the IV bag shortage has gained much attention due to its link to the Puerto Rico hurricanes, health officials say the problem is just one example of various deficits they manage on a regular basis.
Other hurricane-related shortages include certain antibiotics and IV-delivered nutrition, said Crystal Tubbs, associate director of the pharmacy department at Ohio State University Wexner Medical Center. Additional shortages include pain medications and electrolyte fluids, added Dr. Andrew Thomas, Wexner’s chief medical officer.
In all, there are nearly 150 items on a national drug-shortage list and 250 to 275 items that Wexner employees are keeping an eye on, Tubbs said.
The shortfalls can be due to a lack of adequate raw materials, factory shutdowns, recalls or decisions by manufacturers to stop producing certain products, she said. And often, there’s a "trickle-down effect," with lack of one product leading to more reliance on another product that then also becomes difficult to obtain.
When difficulties arise, hospitals might turn to different suppliers, switch to new equipment or seek out alternate medications that will be as effective as the ones in short supply. They must prioritize, using scarce items for patients who have no alternative.
"Some diseases can only be treated by one medication," Thomas said. "We really try to make sure we preserve the limited supply of any medication we have left so that certain subsets of patients who need that medication have it."
(The Daily Jeffersonian contributed to the article by The Columbus Dispatch)