Colorado hospitals are still short on sterile IV fluids after more than a month of rationing. Experts say the shortage could last another three to six months.
“Most hospitals say they have less than 10 days of IV fluids remaining on site,” University of Colorado Anschutz professor of clinical pharmacy Sam Ellis told KUNC. “You have to start to prioritize how you use that supply.”
So far, patients with urgent health issues have not been affected. But, local health care providers, including UCHealth and Boulder Community Health, have begun to postpone elective procedures.
“The goal is to preserve our supplies for patients with emergent and urgent needs,” UCHealth director of public and media relations Kelli Christensen wrote in an email. “We will reschedule these cases as soon as possible.”
Providers also say they are transferring patients to oral hydration, think Gatorade and Pedialyte, in cases where they might normally receive IV fluids. One Reddit commenter in Fort Collins said that their wife didn’t receive her usual IV hydration following a chemo treatment and took longer than usual to recover.
IV fluids have been understocked since Hurricane Helene tore through a Baxter International facility in North Carolina that produces 50 to 60 percent of the IV fluids used by American hospitals in late September. Last week, Baxter announced that the facility was up-and-running at 25 percent of its normal capacity. The company didn’t provide a timeline for a return to pre-hurricane production levels.
The Biden administration mobilized multiple federal agencies to increase the domestic supply of IV fluids last month. The measures, which were implemented under the Defense Production Act, include airlifting IV fluids from foreign suppliers, expediting FDA inspections at the Baxter facility and relaxing the regulations on the shelf-life of IV fluids.
Despite these efforts, experts say that domestic stocks of IV fluids won’t be back to normal for some time.
“Trying to fix this problem through any sort of legislation or remediation in the supply chain is limited at best,” director of the Supply Chain Program at the University of Denver Jack Buffinton told KUNC. “We’re going to see this impact on the IV supply chain for probably six months.”
Buffington sees the current shortage as a symptom of over-concentration in the medical supplier industry. Group Purchasing Organizations, or GPOs, often procure medical supplies for thousands of hospitals and rely on equally large-scale suppliers. He pointed to another IV fluid shortage in 2017 and a recent spike in pharmaceutical shortages as other examples of when this system has failed patients.
“Economies of scale really work, but there are challenges with economies of scale when it comes to resiliency,” he said.
Ellis also stressed the importance of restructuring supply chains in the long term, but he said that the shortage might lead to more local suppliers in the short term. Following the federal government’s announcement, the Colorado State Board of Pharmacy altered its regulations to allow compounding pharmacies to manufacture IV fluids on site. These pharmacies generally create unique forms of drugs that are tailored to a specific patient's needs. Now, they will be able to manufacture small batches of IV fluids with a shorter shelf-life to bolster local supplies.
Providers say that the shortage has also catalyzed collaboration both within and between health care systems. Here in the Front Range, Boulder Community Health has assigned a number of healthcare providers and administrators to an IV fluids task force.
“BCH has a multidisciplinary team evaluating the status of all fluids daily,” a spokesperson from the company wrote in a statement.
Ellis hopes that the momentum doesn’t stop once the crisis is over.
“This isn’t a new problem,” he said. “Long term we have to look at the supply chain issue… the incentives we have in place right now limit the number of generic manufacturers or competitive sources.”
Whether the crisis sparks new reforms remains to be seen. For now, hospitals will do their best to ration supplies until IV fluid manufacturing returns to baseline.
Update: As of 3p.m. on November 5, 2024, UCHealth has stopped postponing elective procedures.
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