Approved Hospital Formulary
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Approved Hospital Formulary
11/4/24 Fluids update: LR to NS in adults
November 4, 2024
The following was sent to the Medical Staff and Nursing today. Please begin converting non-power plan LR orders to NS in adults at Main today. LR will still be available for adult trauma patients where requested, as long as our supply holds out.
As the fluid shortage continues, our biggest issue (outside of irrigation fluids) is the availability of Lactated Ringer's (LR) solution. In order to conserve our dwindling supply of LR, the following steps are being taken:
- Conversion of LR orders to normal saline (NS) on adult surgical power plans - begins Monday 11/4/24
- Automatic pharmacist conversion of non-power plan orders for LR to NS - begins immediately
- Reservation of the bulk of our LR supply to HHWC for use in OB - in progress
- (NOTE: If there is a perceived urgent need for LR in a patient at Main, consult your pharmacist. There may be a delay while the product is transferred to Main from HHWC)
Additionally, there will be a renewed focus on stopping IV fluids on patients who are able to ingest fluids and nutrition orally. Gatorade and Liquid IV are available for hydration. For nutrition, we are strictly enforcing the ASPEN guidelines for TPN - unless the patient has a non-functional GI tract, TPN will not be started. We have also discontinued the use of peripheral nutrition (PPN) and TPN stock solutions, both of which supply sub-optimal nutrition but consume our dwindling supply of fluids and bags.
These changes have been approved by the P&T Committee, HH Medical Staff Office, and HH Administration. We are most appreciate of our medical staff's efforts to conserve fluids during this challenging shortage and, as always, are available to answer any questions or address specific urgent needs. 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