A prolonged shortage of intravenous (IV) solution has begun to take a toll on hospitals and health systems throughout Wisconsin.

In response to a February survey by the Wisconsin Hospital Association, 49 pharmacy leaders responsible for over 70 hospitals and health systems reported actively rationing IV solution to mitigate the effect on their patients and staff, according to a WHA press release.

This shortage in solution is due to the hurricane season in Puerto Rico, where Hurricane Maria damaged, and temporarily closed, major drug manufacturing facilities. Months later, hospitals across Wisconsin and the U.S. have felt the repercussions — small-volume IV bags, amino acids and other treatment therapies are now increasingly unavailable.

WHA vice president of workforce and clinical practice Ann Zenk said WHA was highly suspicious of a shortage following the hurricane. By mid-October, many hospitals had stated a shortage in IV solution, Zenk said.

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As a result of the shortage, a few organizations particularly low on IV solution have been forced to reschedule procedures or send patients to other facilities, according to WHA’s press release. As of now, however, no hospitals have had to transfer patients or postpone treatments.

Hospitals are having to cope with the shortage in solution by implementing different methods in which they administer drugs to patients, which can reduce efficiency among staff and raise healthcare costs, Zenk said. 

Jessica Benjamin, a medical safety pharmacist at St. Mary’s Hospital in Madison, said her patients are fortunate as St. Mary’s is still able to give them the necessary drugs. Benjamin said, however, the shortage has imposed an extra workload on staff.

At an intermediate level, Zenk said, hospitals are no longer using large IV-fluid bags which hang from a pole and drip through IV-fluid lines. Instead, hospitals have begun using syringes to administer fluids to patients.

“Whereas before the shortage we were able to buy ready-made solutions, [pharmacists] now have to compound the fluid ourselves and make it accessible for syringe use,” Benjamin said. “We have to think about now, how will this solution be OK for a syringe.”

This method of treatment does take more time compared to the IV-drip line, Zenk said. Patients with an IV drip can take their treatment with no nurse in the room, but the syringe method requires a nurse to come in periodically and sit by the patient’s bedside to administer the fluid.

Zenk also said substituting certain IV fluids for other IV fluids is also possible in some cases, and all hospitals are willing to share their supply of fluids if a neighboring hospital is lacking.

“We are used to a waxing-waning of shortages in things like small vials of sterile water used for injections, different kinds of medication, etc.,” Zenk said, “But because this shortage has been so prolonged, what we are seeing now is a domino effect. First, it was mini bags, then bigger bags, then IV solution and now syringes.”

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According to Zenk and Benjamin, the shortage of solution has only compounded the effects of the flu season, with a much higher census of patients seeking influenza treatment and needing the necessary fluids to bring them back to health. Combined with the prolonged shortage, the flu season has the potential to be longer too, they said. 

“We have not had to turn patients away though,” Benjamin said. “We are trying very hard to maintain our inventory, to conserve and be mindful.”

WHA is also urging members of the Wisconsin Legislature to sign a letter by the American Hospital Association encouraging the Federal Drug Administration to address the crisis with all its available resources.

While the FDA has recently taken steps to alleviate the crisis by allowing the importation of saline products from other countries and also approving new saline products, the letter addresses hospitals nationwide who are concerned about the uncertainty as to when these products will be available and if there are any long-term solutions to this prolonged shortage.

Hospitals everywhere are hoping to see this shortage come to an end soon, Zenk said.

“We were told it would be months until this shortage ends,” Zenk said. “But now we are hearing relief in the coming weeks and months.”