From: Berkley Sykes  
Sent: Thursday, October 19, 2017 12:18 PM
To: Pharmacy
Subject: Major fluid backorder
Importance: High

We are currently experiencing a major fluid backorder due to Hurricane Maria's impact on Puerto Rico as well as previous allocations. We want to make sure you all know what is going on and to have a sense of the urgency of the situation. 

Mini-bag Plus (MBP) shortage: 
All MBP bags are made in Puerto Rico. We have zero NS 50 mL and we are very quickly running out of our standard NS 100 mL. We are changing what we can to either ADD-Vantage (ADV) vials/bags or to D5W 100 mL.

Now ADV:
Zosyn 3.375 g (profile and non-profile Pyxis)
Ceftriaxone 1 and 2 g (profile and non-profile Pyxis)

Now in D5W 100 mL... all strengths (profile Pyxis only). NOTE - Main and W/C will distribute these exclusively from PSP and W/C pharmacy. These will no longer be loaded in Pyxis. MH: bags are loaded in Pyxis and retrievable per usual. 
aztreonam
cefoxitin
ceftazidime
micafungin
nafcillin

Other shortages that will cause changes in the very near future:
NS 250 mL bags - Logistics is out and pharmacy has a very small stock. There is NO release date. We will be changing products to be standard in D5W instead of NS in the very near future. Pyxis counts have been greatly decreased.
All 50 mL and 100 mL bags - Many of these come from Puerto Rico and we are going to start running low soon. There are several options being considered, but none of them will be easy. We'll keep you posted.
Individually wrapped bags - These are kept in Pyxis so they don't have to be dated and they don't expire as quickly. We will have to use opened bags and begin dating bags. 

If you have any questions or if you or your nurses have problems with iCare of Pyxis or anything else, please let management know ASAP. We've had to make these changes very quickly and have worked hard to try to think of everything, but if something isn't working we want to fix it.

Berkley Sykes, Pharm.D.
Pharmacy Manager - Sterile Products Services