After Hurricane Helene severely damaged an important IV fluid factory, hospitals across the nation are implementing new strategies to conserve supplies.
The storm, which made landfall in Florida in late September, unexpectedly traveled up into North Carolina and caused significant damage, killing over 200 people and destroying hundreds of thousands of homes. It also hit the Baxter International factory, which supplies about 60% of the country’s IV fluid.
IV fluid is a staple in hospitals for the administration of medication, patient hydration, and surgeries. This loss is already being felt in California and throughout the country as hospitals work to manage their remaining supplies.
The Biden administration has invoked the use of wartime powers granted by the Defense Production Act to help speed up recovery, and Baxter International’s own renewal efforts are now in full swing. Temporary bridges have replaced destroyed roads and the company has deep cleaned their buildings. Small amounts of products are expected to re-enter distribution channels in late November, but there still isn’t a timeline for a return to normal production levels.
Hospitals have implemented new policies to stretch their dwindling supplies. Some have canceled all elective surgeries, such as joint replacements or stone removals, while others introduced decision support for physicians.
“The inpatient team has had to get creative to make up for the fact that they can’t do IV hydration like usual and to save IV bags for the people who absolutely need them,” Amelia Satler, a clinical associate professor at the Stanford School of Medicine, said.
“We instituted a new order to remind patients to hydrate themselves, and we bought some electrolyte solutions,” Ann Calcagno, a clinical informaticist at El Camino Hospital, said. Electrolyte solutions are another name for common drinks like Gatorade and PediaLyte. “Having these drinks encourages people to take the fluids they need orally, rather than relying on getting them peripherally through an IV,” Calcagno said.
Hospitals have also improved clinical decision support, a series of technological reminders and alerts that help doctors determine the necessity of their orders. “If doctors are ordering what’s called TKO, a very low amount of fluid, we pop up an alert that reminds them that we recommend they not use that due to the shortage,” Calcagno said.
For patients, the IV fluid shortage has led to uncertainties about their care. “I’ve been waiting to have surgery for over four months now, and I’m worried it will get canceled and I’ll have to wait at least another six months before I could reschedule,” an anonymous Menlo Park resident said. “I have a month off on disability leave to allow me to recover, but if my surgery were to be canceled, I would have no way to get my shifts back and would be ineligible for disability pay, leaving me without income for a month.”
The shortage has also prompted investigations of common hospital practices. “I think the good thing that’s come of this is that it has opened up a lot of discussion for looking at IV fluids,” Calcagno said. Many of El Camino Hospital’s changes to IV fluid administration are likely to stick around after the shortage.
For other physicians, the event has prompted discussion about the medical supply chain. “It really does lead one to wonder why production is so concentrated,” Calcagno said.
“Whenever something like this happens, it opens up this new perspective on how vulnerable the medical system is to our suppliers and how one natural disaster that’s completely out of anybody’s control could have a really big impact across the entire system,” Satler said.
“It also hopefully brings attention to how we as a country need to work together on these things. Oftentimes, we think of health systems as individual entities, and when these things happen, I’m reminded of how we all depend on the same resources to do our jobs,” Satler said. “Hopefully this is motivating people to collaborate and have shared plans for what to do in a disaster, so that we’re all better off the next time something like this happens.”
