Nation, SC feel fallout of IV fluid shortage months after hurricane

The nation continues to face a shortage of intravenous fluids after Hurricane Helene hit Asheville, N.C., in September and damaged the nation’s biggest IV production plant.

The Baxter operating plant, which produces 60% of the nation’s intravenous fluids when at full capacity, is back to pre-hurricane production levels. But some hospitals still are working to become fully stocked with the fluids.

The shortage has caused frustrations but is paving the way for new protocols and long-term changes with the fluids, medications and nutrients that are administered directly into a person’s vein. 

It has been “one of our worst shortages of all time,” said Erin Creech, the medication shortage management and supply chain pharmacist for the Columbia-based Prisma Health System.

Hospitals and doctor’s offices have tried to preserve the IV fluids by using an IV push, instead of an IV drip, which allows healthcare workers to use less fluids. With an IV push, a nurse pushes the IV into the patient with a syringe instead of using a drip bag. Or, a patient could just drink liquids to stay hydrated.

Health officials say the IV push is just as effective but cheaper, though it can sometimes be difficult with certain patients.

One doctor admitted to the downsides of the more time-consuming route.

“When you’re dealing with someone who has dementia, Alzheimer’s, or is confused, trying to get them to drink fluids may be a little tough, so it’s just easier to give IV fluids, and certainly easier on the nursing staff,” said Dr. Seth Parsons, a hospitalist for the Roper Hospital system in Charleston. 

Healthcare providers had to work through frustrations when the typical convenience of IV administration wasn’t accessible. 

“It’s very easy to just reach for IV fluids,” Creech said. “It seemed like a commodity that was never without end.”

The shortage forced workers to take a step back.

“I think this has given us an opportunity to reevaluate the way that we practice medicine,” Creech said.

Parsons said the hospital’s electronic medical record system routinely reminded healthcare workers of the national IV fluid shortage.

“And when you see that, you know, 25 times a day, it just kind of becomes a part of your subconscious that maybe you need to be a little bit more judicious,” Parsons said.

In hospitals, the fluid shortage mainly affected products used to treat things such as alcohol intoxication, nausea, vomiting and malnourishment.

Some patients during the shortage who needed electrolytes that would typically be put into an IV, could instead do something as simple as drinking Gatorade or Pedialyte.

“If the gut works, use it,” Creech said. 

During the shortage, many healthcare providers leaned into that mantra.

“As a provider, what it really stimulates is your creativity to go to your toolbox and say, ‘What else do I have that I can give?’” Parsons said.

Some hospital workers say conservation efforts could become the new normal.

Fool me twice …

Prisma has returned to its old protocols for IV usage after many discussions.

But many other hospitals are considering permanently implementing some of their practices during the height of the shortage.

Caroline Asbill, a pharmacist at Prisma Health Richland Hospital and a University of South Carolina professor, said the hospital could revisit conserving IV fluids.

Other hospitals, such as the Roper Hospital System in Charleston, are juggling with the question of whether to keep protocols that include the IV push method as first string options.

“I think if you talk to hospital administrators, (these are ways) for the hospital to save money,” Parsons said.

This is not the first time there has been a shortage of IV fluids due to a natural disaster. And this is not the first time the shortage has been caused by damage to a Baxter plant. Baxter has plants throughout the country and around the world. 

Category 5 Hurricane Irma damaged the Baxter healthcare facility in Puerto Rico in 2017. 

“That one was really terrible. That one really affected the whole global supply,” Parsons said. “We had difficulty getting antibiotics, life-saving antibiotics, common antibiotics, IV fluids.”

Some hospitals are considering having more than one supplier.

“We don’t necessarily want to be caught with our hand in the cookie jar,” Parsons said. “We want to have multiple cookie jars. So I know for Roper Hospital System, they had other suppliers that they were getting IV fluids from. It’s kind of like, ‘Fool me once, shame on you. Fool me twice, shame on me.’” 

The process

The past few months have required a lot of communication among healthcare providers.

Prisma compiled a materials distribution team, calling it “a joint collaboration between physicians, pharmacy and supply chain.”

Conversations among team members created checks and balances.

“The pharmacists would definitely call us if they thought that we were giving too much IV replacement, or if they just didn’t have enough bags,” Parsons said.

The communication efforts, combined with the protocols implemented, helped hospitals stay afloat while Baxter got back on its feet.

“I think they’ve done a great job,” Creech said. “I will give it to Baxter. … They were fabulous in just unprecedented scenarios.”

Hospitals, meanwhile, have arrived at the light at the end of the tunnel, with elective surgeries being rescheduled because Baxter is up to full capacity. 

“It really pushed us all to be creative and resilient,” Creech said.