Concentrated sodium chloride is on backorder (likely until September), and in addition to David's TPN recommendations below please review 1/4 NS alternatives.

1/4 NS: For adults, the nephrologists have approved and agreed to not use 1/4 NS. If you receive ANY order for 1/4 NS, contact the prescriber to get orders for alternate therapy. (Recommendations include D5W, 1/2 NS, and alternating 1/2 NS with D5W. There is a very limited supply of commercially available D5W 1/4 NS in PSP).

Please contact Chris Pamperin or myself if you have any questions.

Thanks,

Sam

Samantha Rustamov, Pharm.D., BCPS
Supervisor, Pharmacy Professional Services
Huntsville Hospital Department of Pharmacy

From: David Collette
To: grp allpharm
Sent: Thursday, March 8, 2018 1:24:12 PM
Subject: electrolyte shortages

We are facing one new critical shortage and one new looming shortage...and both may impact TPNs:

    * Our concentrated saline supply is down to about 2 weeks. Please provide only the minimum amount of sodium chloride possible. This is a great time to reiterate our "if the gut works, use it" policy whereby only those patients that are unable to take oral or tube feedings are administered TPN. One possible alternative is to provide NS in 500 mL (we have a decent supply from Kabi at this time) as a separate infusion to preserve our conc'd saline supply.
    * Our KCl supply is also dwindling, but not as critical as concentrated saline...yet. Again, conservation is key and stopping all unnecessary TPNs is the best solution.

Please make these adjustments in TPN now and (like IV narcs and IV fluids)... PICK P.O.!!
--
David R. Collette, Pharm.D., FASHP
Operations Manager, Professional Services