A Shortage of IV Resources ... and Medications

While the nationwide shortage of IV fluids through injection bags has been felt since Hurricane Maria disrupted many production facilities in Puerto Rico last September, some Massachusetts hospitals have also begun to refocus attention on the shortages of various basic medications.

Of particular IV concern is the ongoing shortage of sodium chloride 0.9% injection bags, which are smaller in size and are used to inject drugs intravenously in hospital and outpatient settings. Baxter Healthcare Corporation’s facilities in Puerto Rico that produce those bags were knocked out of operation by the hurricane and only recently resumed production.

Last November, the FDA temporarily allowed the importation of IV saline products from facilities outside of the U.S. and encouraged the expansion of production at existing facilities to meet shortfalls.

But the shortages have continued and worsened in recent weeks as incidents of flu have risen.  Hospitals are employing “conservation and adaptation strategies”, such as using larger IV bags in place of the smaller bags, which, in turn, has caused a shortage of the larger bags.  The American Hospital Association held a member call last Thursday to discuss the issue with Baxter, which said its operations on the island continue to improve, but that the overall situation in Puerto Rico is of concern.

As the IV-bag issue played out across the U.S., some member hospitals have reported to MHA another concern – sporadic supply shortfalls of a host of medications, ranging from antibiotics, basic KCL (potassium chloride), lorazepam (brand name Ativan), local anesthetics such as lidocaine or bupivacaine – among many others.  Some hospitals are reporting that the understandable focus on opioids such as morphine and hydromorphone (Dilaudid) has caused a shortage of these drugs as well, which has had an effect on pain management in controlled hospital settings.

Why are the shortages occurring? A review of drugs listed on the American Society of Health-System Pharmacists (ASHP) website shows that manufacturers often cite supply-and-demand issues, but often give no reason at all for the shortages.  Said one frustrated Massachusetts hospital pharmacy manager, “A big part of it seems to be drug companies buying up companies that make generic drugs, and then turning off the spigot to keep the prices up.”