From: David Collette  
Sent: Monday, October 23, 2017 3:06 PM
To: Pharmacy
Subject: severe national shortage of IV piggybacks
Importance: High

I wanted to let you know about the severe shortage of many IV products, especially Mini-bag Plus bags (with NS being especially hard hit). PSP has already implemented several steps to mitigate this shortage, including use of D5W Mini-bag Plus when compatible and AddVantage bags as available. (There were some initial issues regarding the nurse's ability to obtain the drug from Pyxis when it was entered as a Mini-bag Plus but supplied as AddVantage, but that issue has since been resolved.) It is very possible that we will have to resort to making more and more products in syringes, which will have to be administered either via infusion pumps or IV push by the nurse. Please review the email below in case you get questions about this shortage.

Due to the devastation of Puerto Rico by Hurricane Irma, there is a critical national shortage of IV piggyback bags used to deliver many drugs, including a large number of commonly-used antibiotics. All Mini-bag Plus bags were manufactured in Puerto Rico and this is now having a ripple effect on the availability of all other piggybacks, including AddVantage bags. Our Mini-bag Plus allotment has been cut in half and there are very few normal saline piggybacks available to us. We have already taken several steps to conserve our dwindling supply of piggybacks, including:

• switching several commonly-used antibiotics to AddVantage bags

• switching some products to D5W (when compatible) and admixing in Pharmacy Sterile Products, as long as the supply holds

• imposing a moratorium on loaning all IV piggyback bags to other institutions

Additionally, the FDA has reviewed the importation of IV piggybacks from overseas, but no final word has been received, yet.

It is a very real possibility that we will exhaust our supply and allotment of IV piggybacks and be forced to move to the more labor intensive process of making and administering many of these products in syringes. Pharmacy is in the process of determining which of our IV piggyback drugs can be delivered via syringe, either using a syringe pump or by slow IV push. Both of these have implications across the health-system, including the need for additional syringe pumps or the time required for the nurse to push the drug over 5-10 minutes. For drugs that require a shorter administration time (e.g., 2-5 min push), some institutions are supplying vials to the nursing units for nurses to reconstitute and push over the designated time. A combination of these approaches will likely be necessary if we are unavailable to obtain an adequate supply of IV piggybacks.

In addition to the shortage of IV piggybacks, other IV solutions are in short supply. The allocations for NS 500 mL and LR bags are very low and NS 250 mL bags are unavailable. We are resorting to supplying NS in 1L bags at this time. 

We will keep everyone apprised of the status of this shortage and work together across disciplines to reach a solution to provide the needed drugs for our patients. If you have any questions about this shortage and it's implications for Huntsville Hospital Health-System, please do not hesitate to contact me.

DAVID
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David R. Collette, Pharm.D., FASHP
Operations Manager, Professional Services