WORCESTER - Local hospitals are grappling with the shortage of intravenous bags and fluids caused by the temporary shutdown of manufacturing plants in Puerto Rico following Hurricane Maria. The storm devastated the island and wiped out much of its power grid in September.
Representatives of St. Vincent Hospital and UMass Memorial Medical Center say that through proactive planning, they've been able to adjust.
"We have not canceled a surgery. We have not compromised patient care," said Paul Paladino, director of pharmacy at St. Vincent.
He said that because St. Vincent is part of a national chain, Tenet Healthcare, the hospital system has worked with a range of suppliers and been able to maintain enough inventory to meet patients' needs. Some of that includes "reverting to what we've done in the past," such as administering medication through syringe injection, rather than from a hanging IV bag, and having patients drink fluids and prescribed nutrition, if they're able.
According to Boston news reports, Massachusetts General Hospital was administering Gatorade to a patient through a stomach feeding tube because of the supply shortage.
"We haven't had to resort to anything quite that drastic yet," Mr. Paladino said.
The storm's impact on hospital care throughout the United States highlighted a vulnerability in the supply chain. Mr. Paladino said, "People didn't realize how much stuff was actually being produced in Puerto Rico."
The U.S. Food and Drug Administration reported last week that Baxter, a major supplier of IV bags and fluids, has gotten all its Puerto Rican plants back on the commercial power grid, although the grid remains fragile in some areas. Commissioner Scott Gottlieb said he expected production to increase and the problem to abate over the coming weeks.
The FDA has also allowed Baxter to import supplies from Ireland and Australia to supplement production from Puerto Rico.
The shortage includes IV bags used to contain fluids as well as fluids used for hydration, nutrition and to dilute medications from antibiotics to narcotics as a method of delivery.
UMass Memorial Medical Center has a Critical Drug Shortage Task Force, which has been dealing with changes in the manufacturing landscape and resulting shortages for several years. According to Roland Bercume, senior director of pharmacy, shortages of medications occur as companies merge or products are discontinued. Hurricane Maria ramped up what was already an area of concern.
"It has a major ripple effect on products we use each day," Mr. Bercume said. "It's a challenge, but we have two main goals: to keep our patients safe and deliver effective drug therapy."
Neil Gilchrist, manager of pharmacy operations at UMass Memorial Medical Center's University campus, said the health care system communicates daily across sites on inventory, rates of use and clinical implications.
The current shortage of IV solutions, which are a delivery mechanism for so many other drugs, "has a much broader scope of impact" than previous shortages, he said.
"We've managed to maintain enough supply," Mr. Bercume said. "We won't rule out anything that's safe and effective."
Working with clinical staff, UMass Memorial's team has switched to oral medications and syringe injection where possible. The hospital system is making sure it's looking into all legitimate supply markets and alternative preparations such as using its own compounding room for some medications.
"All these strategies are on the table and it's a moving target," Mr. Bercume said. "We're being very proactive and looking down the road, so that by the time we need to implement the strategy, it will be worked out."