ASCA Asks HHS to Increase Efforts to Combat IV Shortages

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ASCA Asks HHS to Increase Efforts to Combat IV Shortages

ASCs face unavailability of fluids; emphasize importance of emergency preparedness plans

An intravenous (IV) solutions shortage has gripped the nation since Hurricane Helene made its landfall on September 26. Much of the shortage is due to Baxter’s manufacturing site in North Cove, North Carolina, shutting down production after Helene’s rain and storm surge flooded the facility. This Baxter facility supplies approximately 60 percent of the IV solutions used every day in the US.

Baxter is updating its website as new information is released.

Last week, ASCA sent a letter to US Department of Health and Human Services (HHS) Secretary Xavier Becerra regarding the IV solutions shortage. Since ASCA sent the letter, the US Food & Drug Administration (FDA) has allowed for temporary imports of certain IV fluids as healthcare facilities across the country struggle with the shortage. A spokesperson for the Biden administration has said that the federal government is wielding the Defense Production Act to rebuild the Baxter plant as quickly as possible.

In its letter, ASCA also requested that a national public health emergency be declared to allow for waivers of the Centers for Medicare & Medicaid Services (CMS) rules and regulations to help alleviate the growing problems associated with sterile IV shortages. In addition to declaring a national public health emergency, ASCA advocated for HHS to continue working with and encouraging FDA to declare a shortage of sterile IV solutions to allow for certain flexibilities not otherwise available to healthcare providers.

The shortage is affecting surgery centers. “Much like the rest of the country’s medical world, we are struggling to manage the national IV fluid shortage,” says Dan Stannard, RN, CASC, administrator of Red Hills Surgical Center in Tallahassee, Florida. “We are continuing to work with our vendors to find every allocated bag/bottle of fluids we can, while working with our physicians and staff to reduce waste and promote a higher level of awareness of fluids use. At this point, we have about two weeks’ worth of IV and irrigation fluids in-house and are doing our best to find a long-term solution, while living a week at a time hoping that the shortages are short lived.”

East West Surgery Center in Austell, Georgia, and Northwest Georgia Orthopaedic Surgery Center in Marietta, Georgia, are not facing any IV supply issues at this time but are “preparing, documenting, reporting to the parent company and continuing to order,” says Jean Calhoun, RN, regional administrator of the ASCs.

“Unfortunately, like the rest of the country, we are facing an IV shortage due to the damage Hurricane Helene inflicted on North Carolina, but we are doing fine with our allocations of IVs,” says Linda Nash, CASC, administrator and risk manager of Manatee Surgical Center in Bradenton, Florida. “We use flushes for our cataract cases, so that saves on IVs. We just have to be careful and make sure we order all our allocation, so it does not go to some other center. [We are] hoping that Baxter can import IVs from their five other plants outside of the US that the FDA gave permission to import.”

Before the Hurricanes

Hurricanes Helene and Milton brought to the forefront the importance of emergency preparedness plans in ASCs.

Part of preparing for a hurricane starts at the beginning of the hurricane season “when you get your professional tree trimmer to trim oak trees, so the wind blows through them and doesn’t knock them over,” Nash says. “Make sure palms are free of fronds and drainage areas are clean.”

Manatee Surgical Center, located nine miles east of Anna Maria Island, did not sustain any damage from the hurricanes but had to shut down for four days. Anna Maria Island, hit by both Helene and Milton, was destroyed, Nash says. “I am lucky that my home damage—destroyed barn and half of my metal house roof—was not as bad as some I have seen,” she says.

On October 6, three days before Hurricane Milton made landfall in Florida, Nash made the call to cancel more complex cosmetic procedures that would have made evacuation difficult. “We activated our emergency management plan (EMP), and we texted all our team members to see who planned on staying and who was evacuating,” she says.

On October 7, Manatee completed its gastrointestinal cases and some ENT procedures before Nash decided to close the center on October 8 to give her team time to prepare their homes for a possible Category 3 or 4 hurricane. “The team prepared the center by turning off and covering all equipment in the business office, preop and PACU,” she says. “We wanted to limit damage to equipment if we had a roof failure, and the ceiling tiles do not prevent water damage. In the ORs, the ceiling is solid, so all equipment was unplugged and off the floors.” Before leaving the center on October 7, Nash turned off the ASC’s emergency generator to preserve fuel, so it could reopen with plenty of fuel.

On October 9, “we rode out the hurricane, praying we all survived, and our center was still in one piece,” Nash says. “On October 10, my assistant—she lives close to the center—was able to get to the center and look for any damage. None was found and the center had power. Internet was down and has been for a week. Hopefully, we will get it back soon.”

Nash decided to keep the center closed after the hurricane to give her team members time to clean up their own properties and let the city get the streets cleared of debris. The ASC reopened on October 14. Given that the center had no internet, it could not access its EMR and went back to paper charting. “Our IT guy was able to piggyback our internet to our phone internet and by October 15, we had our EMR up and running again,” she says.

“I felt our EMP worked well and we knew where all our team members were,” Nash says. “Follow-ups after the storm let us know who had power and who had damage. Staying in touch with your team is very important and it lets them know that you really care about them. Make sure you have key team members who live close to your ASC so they can easily check on the facility as soon as it is safe to venture out. Make sure ahead of time you have contacts of people who can clean up debris [and] fix any damage, so you can get back to work as usual as soon as possible.”

East West Surgery Center and Northwest Georgia Orthopaedic Surgery Center also put their emergency preparedness plans in motion even though the ASCs were not directly in the storms’ paths, Calhoun says.

“We put our inclement weather policy into place and communicated that to staff,” Calhoun says. “The administrator contacted surgeons as to [the] plan, and surgeons contacted patients on what to expect. All leadership left the facility with printed schedules and phone numbers in case of a power outage and inability to utilize laptops. All leadership was encouraged to keep cell phones charged. Our OR schedule was delayed by four hours. We gave staff the option to report based on safety, and we had six procedures canceled.”

The surgery centers’ inclement weather policy is multifold, Calhoun explains. The medical director is in charge of the ASC. The administrator is in charge of surgeons, anesthesia notification and the parent company. The clinical director is in charge of all clinical staff. The chief financial officer is in charge of patients and business office staff. The materials manager is in charge of all materials and representatives. And the parent company has an established emergency preparedness department as support.

“Safety comes first for patients, staff and surgeons,” Calhoun emphasizes. “We do elective surgery, not emergent or life-threatening surgeries. Our surgeries can be postponed. Only proceed when safe.”

ASCA has created a webpage with links to the most recent developments in Baxter’s hurricane response and additional resources.

Listen to ASCA’s audio update on the national IV solutions shortage.