As soon as a shortage becomes evident, first off, “the facility medical staff leadership in concert with the pharmacy consultant, should preemptively discuss formulary alternatives for drugs,” Sones suggests.
“Look for alternative and substitute products,” Hovasse says. “You might also want to look at other units of measures that you do not typically use. Look at all distributors: primary, secondary and local. As a one-stop shop, PurNet is a national purchasing network that makes numerous calls on our behalf to various manufacturers and distributors for the products in shortage and alternatives.”
Vortherms says, “We call all the other distributors who might be able to beg, borrow or steal. However, ASCs might want to be prepared to get to a point where they have to perform the surgeries that are absolutely needed and hold off on the elective surgeries.”
As second step, “exercise prudent formulary management and enforcement to assure that you are not engaging in over- or misutilization of drugs that might be regarded as ‘unnecessary,’ such as antibiotic usage in routine colonoscopy procedures,” Sones says.
To that end, educate your staff, Hovasse says. “Your director of nursing and clinical managers need to be aware of the shortage or the possible shortage, so we use the product most efficiently, to the best of our abilities.”
To fight the current shortage, Hovasses’ ASC is trying to place as many orders as possible with as many vendors as possible. “We are looking at different units of measures and looking at alternate products, such as Normosol for lactated ringers,” she says. “We are also using alternative vendors such as Viaflow, manufactured in Spain, instead of B. Braun or Hospira.”
One of the medical supplies that Hurricane Maria disrupted the production of is smaller-volume bags of IV solutions.
“Everybody needs IV solutions,” Vortherms says. “We have been facing IV shortage for the last 3–4 years, but I have not seen a shortage this bad in my 35 years of materials management. Some ASCs might have to shut down for a couple of weeks to get caught up with the IV solution shortage.”
To buy IV solutions through wholesalers, Sones advises investigating direct ordering through the manufacturers. “Have those orders in play as you seed your orders with your wholesalers,” he says. “Reality is that hospitals might be ‘bumped’ to the top of the distribution list by wholesalers, so multi-wholesaler relationships that are nurtured in the course of the periods where shortages are not problematic might, similarly, be fruitful.”
The good news is that the manufacturer of IV solutions that got hit by Hurricane Maria, Baxter International, recently got permission from the FDA to import them from its offices in Australia and Ireland.
The other way the government could help with the saline shortage is to not let B. Braun shut down its California plant for three weeks in December for “critical maintenance work,” Vortherms says. “Customers are already experiencing back orders and B. Braun’s letter to its customers states, ‘ … we anticipate that this situation will continue through the first quarter of 2018.’ The government needs to step in and do something to stop worsening the saline shortage further with this plant shut-down.”