IV Fluid Bag Shortage: Talking Points

Below are some important talking points for patients, caregivers and visitors about the situation at the MGH and throughout the U.S.

I heard that there is a shortage of bags of IV fluids. If I need IV fluids, will I get them?

If IV fluids are the best option for you, you will get them.

Will the IV fluid shortage affect my care?

Our top priority is to provide you with the highest-quality care. We can often use pills or liquid medications instead of medications that are delivered by IV fluids.

What products are affected by the shortage?

Bags of IV fluids are in short supply throughout the United States.

What are IV fluids?

They are sterile fluids in a bag that are given directly into a vein.

Why there is a shortage of IV fluids?

Medical product factories in Puerto Rico that make IV fluids were damaged in Hurricane Maria. This has caused a shortage of IV fluids throughout the United States.

When Hurricane Maria pummeled Puerto Rico last September, it caused widespread devastation – leaving homes destroyed, businesses leveled and manufacturing plants in ruins. When the facility that produced 40 percent of the nation’s IV fluid bags was rendered inoperable, it set into motion a shortage that has impacted hospitals throughout the United States.

Since October, the MGH – which uses tens of thousands of bags of fluid on a weekly basis – has been actively addressing the IV fluid bag shortage, implementing adaptive strategies, launching its emergency Hospital Incident Command System to help coordinate the response, and creating a multidisciplinary work group to meet daily to further brainstorm safe, effective ways to conserve fluids while continuing to maintain the highest level of quality. On Jan. 9, hospital leaders also hosted a “Town Hall: IV Fluid Bag Shortage” meeting in the O’Keeffe Auditorium to provide a status update and field questions from staff. A video of the presentation is now available for viewing on Apollo, the MGH intranet.

“Since almost the moment the hurricane hit Puerto Rico, we’ve been working on this situation,” said Paul Biddinger, MD, chief of the Division of Emergency Preparedness. “People have been taking really heroic measures long before this became a crisis. But I want people to understand this is not just a Mass General problem. It’s not just a Northeast problem. It’s a national problem.”

Biddinger explained that hospitals subscribe to a “just in time” inventory methodology, similar to many other industries in the country. “We as a hospital, on average, have on hand three days of consumable items. When we use these supplies, we order new things from the distributor, who then orders it from the manufacturer to replace them. And that’s great – unless there is a hiccup in the flow, which there now is. That is the situation we are in right now.”

One of the hospital’s early initiatives was described by O’Neil Britton, MD, chief medical officer, who helped to identify “Service Lead” physicians who work closely with Nursing and Pharmacy leaders to coordinate conservation efforts in each unit. “These groups have assumed responsibility for daily rounds to review all IV fluid and IV medication orders for every patient,” Britton said.

Sue Algeri, RN, associate chief nurse, and Colleen Snydeman, RN, director of Quality and Safety for Patient Care Services, provided an overview of a few of the many conservation strategies the hospital has implemented, including providing patients with oral alternatives for all possible medications – particularly electrolyte repletion and antibiotics, promoting oral hydration by substituting IVs with water, Gatorade or Pedialyte, and using intramuscular injections for medications when available. And, Jim Lund, director of Pharmacy Operations, reviewed current medication inventory status and outlined how Pharmacy staff perform daily assessments with Materials Management regarding the allocation of supplies between units and the Pharmacy.

All speakers stressed that, while the shortage is a serious situation, it has not adversely impacted patient care. They all commended staff for their diligence and dedication during the past few months.

“This is what we do best,” Snydeman said. “We leverage the interdisciplinary teamwork and relationships that you all have at the unit level – that’s exactly what’s happening. We thank you all for this important work.”

MGH staff: For more information, visit apollo.massgeneral.org/ivfluids.

Read more articles from the 01/12/18 Hotline issue.