Approved Hospital Formulary
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Approved Hospital Formulary
10/8/24 new IV shortage info
October 8, 2024
Here is a quick update on the IV fluid situation; I am including our System hospitals and Tracy for situational awareness.
- Most elective orthopedic, urologic, and gynecologic surgeries are canceled, effective tomorrow
- We will NOT be supplying IV fluids to OPM for basic hydration; we will continue to see and treat the bariatric patients who had surgery at HH as well as our Sickle Cell patients (as long our fluid supply holds) at OPM
- TPN bags are in VERY short supply and all possible patients must be converted to oral/enteral. The following info is being sent to the HH Medical staff this morning:
- As you know, there is a national shortage of IV and irrigation fluids due to the historic floods in NC. Additionally, pre-filled saline flush syringes and empty IV bags are also on severe allocation.
- Currently, we have enough IV bags to make TPNs for approximately 10 days (based on today's usage). It is highly likely that we will receive no further empty IV bags this week, so it is imperative that we only admix TPNs for those patients in who it is absolutely necessary.
- ASPEN guidelines for adult TPNs have stated for decades that "TPNs should be used only (except in limited specific situations) in malnourished patients with non-functional and/or non-accessible GI tracts." Central lines pose significant infection risks, which is only compounded by the infusion of protein, dextrose, and lipids contained in TPNs.
- Our Nutrition Support Team (NSS) will be carefully evaluating all orders for TPN and working with providers to transition to alternate means of providing nutrition where appropriate. Encouraging oral intake and initiation of tube feeds are appropriate alternative to TPN in many patients; NSS team members will be reaching out when these modalities are deemed feasible. HH dieticians are available to work with patients to maximize PO intake. Additionally, during this shortage we will NOT be admixing PERIPHERAL nutrition solutions (PPN) since these require a relatively large volume of fluid to provide relatively few calories.
Please work with your nurses and physicians to do what is necessary to protect our dwindling supply of IVs. As stated previously, aggressive IV-to-PO conversion and fluid conservation are the major strategies to preserve IV fluids and bags. If you meet with unreasonable prescriber resistance or have questions about specific situations, you are welcome to call me (256-527-2560).
Thanks for all of your hard work and for doing whatever it takes to make sure that we can treat our most critical patients. DAVID
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David R. Collette, Pharm.D., FASHP, FALSHP
Operations Manager, Professional Services
Huntsville Hospital Department of Pharmacy
101 Sivley Road, Huntsville, AL 35801
Desk: (256) 265-6741; Cell: (256) 527-2560