In the battle against COVID-19, supply chain uncertainty emerged as one of the health care industry’s more formidable foes. How can you ensure quality care when shipments of everything from PPE to pre-filled syringes are delayed or diminished by disruptions beyond your control?
We know that mitigating the impacts of shortages can be difficult, but strategic preparation makes it less so. Such strategies predate the pandemic — the shortage of IV solutions experienced after Hurricane Maria hit Puerto Rico in 2017 serves as a particularly useful case study.
The Category 5 storm damaged and temporarily shuttered several factories owned by a major manufacturer of IV solutions, forcing health care organizations to immediately implement strategies to manage limited inventory. In reviewing those who most successfully navigated that challenge, we found they had several tactics in common.
Conservation should be part of your normal supply strategy even in non-crisis situations since it allows for reduction of waste when supply is adequate, and the ability to sustain operations and provide patient care during shortages. Conservation strategies surrounding IV solutions include:
- Deliver IV fluid based on patient need. When maintenance fluid is required, consider empirically proven weight-based fluid maintenance protocols — this method may result in a smaller total volume infused than a standard infusion rate approach. The need for other forms of fluid administration such as fluid resuscitation, replacement and redistribution should be assessed and administered until the patient’s condition is stable. Discontinue when no longer needed.
- Oral intake is recommended for medically stable patients. A thorough patient assessment must be performed, and the physician must provide an order for patients to transition from intravenous to oral administration. Consult a pharmacist for a clinically equivalent oral conversion of any remaining IV doses. If an oral form of a required medication is unavailable, consider alternative equivalent forms when possible, such as IV push, intramuscular, subcutaneous or intra nasal doses. Again, this requires a physician order, and a pharmacist should be consulted.
- Utilize smaller volume fluid bags whenever possible. And discontinue the patient’s IV, with a physician order, if no longer needed.
Collaborative strategies for providers
The providers most successful at mitigating the post-Maria IV fluid shortage appointed an internal team of stakeholders from every affected area of the hospital, including (but not limited to) representatives from clinical staff, pharmacy, dietary, supply chain and education departments. The teams handled multiple responsibilities, including developing systemwide policies, procedures and communication strategies, implementing enhanced inventory assessment and tracking protocols, and scheduling meetings with the interdisciplinary team and supplier/manufacturer representatives.
Beyond involvement in meetings, providers should always look for ways to partner with their GPO and supplier to help protect against shortages. We discovered the organizations most successful in navigating the IV fluid shortage had signed a Letter of Commitment to at least one supplier — while they weren’t getting everything they needed, they were receiving some product on a regular basis. And, when possible, many organizations also sought out secondary supplier agreements for additional inventory.
We also encourage providers to consider doing the following to improve communication and mitigation strategies when shortages happen:
- Get to know the supplier’s field representatives. They are the first line of communication between providers and suppliers and can help providers understand product availability, especially during allocation periods.
- Gain a better understanding of the distribution channels and options for alternative suppliers.
- Work proactively with your GPO to escalate supply challenges, understand purchasing options and supply chain status, and receive timely updates on supplier and manufacturer contingency plans.
Strategies for supply chains
From a supplier perspective, we found that Hurricane Maria served as a catalyst for several risk mitigation strategies including:
- Investment in U.S. mainland production capabilities
- Efforts to optimize supply chain operations and create manufacturing redundancies where appropriate
- Implementation of import registration strategies in the event the U.S. supply is compromised
- Investment in technology and e-services to provide more timely information
Plan for the long haul
No matter what strategy you decide to put in place, make sure it’s a sustainable one. More often than not, the tendency is to implement an intervention, such as a conservation strategy, based on a perceived or actual product shortage. But once the shortage ends and allocations are lifted, the tendency is to revert to customary practices and procedures. Just as important as putting those process improvements in place is ensuring your gains aren’t lost once a crisis is over.
To learn more about Vizient’s efforts to increase resiliency, enhance visibility and improve access to supplies and essential medications, visit vizientinc.com/supply-assurance.