As the voice for all infusion providers across the nation, NICA has new guidance on preparing for and navigating potential disruptions to supply distribution or supply shortages as a result of recent hurricanes.
Hurricane Helene forced Baxter International, a leading supplier of IV bags to the United States, to temporarily close its North Cove, North Carolina facility. The North Cove facility, responsible for producing 1.5 million IV bags per day, represents roughly 60% of the country’s IV bag supply (Mayer, 2024).
While Baxter is working diligently to leverage their global supply network in an attempt to mitigate critical supply shortages, it is also crucial for infusion providers to prepare for the potential effects.
As North Carolina and its hurricane-affected communities continue to work through the challenges presented in the aftermath of Hurricane Helene, a new weather system, Hurricane Milton, has made landfall and begun barreling across the Florida peninsula.
Based on the situation in North Cove, NC, and in preparation for Hurricane Milton, some manufacturers have been working diligently to get a reserve of IV bag supplies out of the area to avoid damages to product.
Due to the severity of the damage to these major manufacturing plants and the direct effect on patient care, the United States Food and Drug Administration (FDA) has approved shipments of necessary supplies from overseas plants.
While the weather is out of anyone’s control, there are steps you can take within your infusion organization to stay ahead and be prepared. We are here to help!
Strategies to Prepare for Small Volume IV Fluid Shortages
1. Assess Current Inventory and Immediate Needs
Begin by assessing your existing stock of IV fluids and estimating how long this supply can last based on current demand (i.e. patients currently scheduled). Categorize the medications that rely on these fluids, prioritize critical therapies, and calculate potential shortfalls. Establish a system to closely monitor supply levels, alerting staff to real-time changes. This will allow your team to make informed decisions about rationing and substitution when needed.
2. Know Which Medications Can Use Alternative Diluents
Not all medications are limited to a single diluent, and understanding which ones can be safely prepared using alternatives can help conserve these critical IV fluids. Reference the manufacturer’s prescribing information to identify if an alternative diluent is acceptable. Another option is leveraging the RxToolKit RxWorkFlow solution, which has over 280 user-friendly medication guides.
Here are three examples of medications that allow alternative diluents according to their product information (PI):
- Actemra: Can be diluted with 0.9% or 0.45% Sodium Chloride Injection, USP
- Entyvio: Can be diluted with 0.9% Sodium Chloride Injection, USP, or Lactated Ringers
- Rituxan: Can be diluted with 0.9% Sodium Chloride Injection, USP, or 5% Dextrose in Water
- Soliris: Can be diluted with 0.9% or 0.45% Sodium Chloride Injection, USP, 5% Dextrose in Water, or Lactated Ringers
However, some medications require strict adherence to a specific diluent:
- Infliximab: After reconstitution with Sterile Water for Injection, USP, infliximab must be diluted with 0.9% Sodium Chloride Injection, USP only
- Ocrevus: Requires dilution with 0.9% Sodium Chloride Injection, USP, only
- Tepezza: After reconstitution with Sterile Water for Injection, USP, Tepezza requires dilution with 0.9% Sodium Chloride Injection, USP, only
Knowing which medications have alternative diluents and which do not will be crucial in planning during a shortage.
3. What if the PI Does Not List Alternatives?
If the product information for a medication does not specify alternative diluents, it is essential to contact the drug manufacturer. Most manufacturers have a medical science or medical affairs division that can provide detailed guidance on safe alternatives. Additionally, they may offer advice based on stability data, pharmacokinetics, and compatibility studies. Contact your local pharmaceutical representative to connect you with the appropriate department for this information.
Establishing a relationship with these departments before a shortage occurs can save time and ensure that you have reliable information when you need it most.
4. Review and Update Order Sets
Infusion centers rely heavily on pre-established order sets, which include detailed instructions on which diluents and volumes to use. A critical step in preparing for an IV fluid shortage is reviewing these order sets. Ensure that they specify not only the primary diluent but also any acceptable alternatives as outlined in the PI.
If your current order sets do not include flexible options for alternative diluents, start revising them now. These revisions should allow pharmacists and nurses to make substitutions without having to consult additional references during a crisis and changing the order, ultimately streamlining care delivery.
Alternatively, creating a supply shortage standard operating procedure (SOP) that outlines emergency response processes could also be an effective approach. Your SOP must include a medication-specific review process to identify acceptable alternative diluents that can be auto-substituted in compliance with manufacturer guidelines. Ensure that this information is easily accessible to staff, either through electronic medical record (EMR) systems or physical copies in the preparation area. Clear communication about these changes is key to ensuring that your team is prepared to adapt to evolving supply constraints.
Final Thoughts
Preparing for IV fluid shortages is not just a matter of having enough stock on hand and panic stockpiling. It requires careful planning, reviewing order sets, and ensuring that your team has access to the necessary information required to make safe substitutions. By starting these preparations early, infusion centers can ensure no disruptions to patient care, even during a prolonged shortage.
With lessons learned from past disruptions from natural disasters and manufacturing issues, infusion providers can implement strategic measures to safeguard their operations in the face of future shortages.
To receive status updates from Baxter International, please visit: https://www.baxter.com/baxter-newsroom/hurricane-helene-updates
References:
Mayer, Chloe. (2024, October 9). Hospitals Face Shortages Nationwide After IV Fluid Maker Hit by Helene. Newsweek. https://www.newsweek.com/iv-dialysis-shortage-hospital-baxter-hurricane-helene-1965566
About the Author
As the Director of Clinical Education for the National Infusion Center Association, Monica Parson, RN, has experience as an infusion therapy nurse, Clinical Resource Manager for an MSO, and Director of Quality and Compliance. This experience is crucial in her efforts to develop resources and training material to support infusion centers and stakeholders. Prior to joining NICA, Monica successfully led multiple ambulatory infusion clinics through accreditation programs.
About the National Infusion Center Association
NICA is dedicated to ensuring that the nation’s infusion centers remain a safe, more efficient, and more cost-effective alternative to hospital settings for consistent, high-quality care.
Infusion providers have a vested interest in the sustainability of the infusion delivery channel and its ability to serve vulnerable patient populations. NICA Provider Members have a voice and a seat at the table to inform NICA’s activities and the opportunity to remain highly engaged in the expansion and optimization of the infusion industry. Learn more about becoming a NICA member here: https://infusioncenter.org/join-nica/
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