The ability of healthcare systems to be adaptable when facing national or global supply shortages is essential to maintain normal operations and high-quality outcomes. Although Walter Reed National Military Medical Center has alternate medications and supplies available for clinical use in the event of a shortage, we did not have a readily available “off-the-shelf” guide for our logistics team to quickly identify, inventory, and distribute these resources.
Recognizing that this may delay the identification of alternate medications and supplies in the likely case of future shortages, Walter Reed National Military Medical Center leadership directed the creation of an action plan that would tie together logistics, pharmacy, and medical staff to quickly identify whether a shortage was a critical item and the most feasible alternatives. Upon creation of this plan, we were quickly given an opportunity to exercise it as Hurricanes Harvey, Irma, and Maria in the Caribbean islands significantly affected the U.S. supply of crystalloid solutions. The affected items were 1-L bags of lactated Ringer’s (LR) and 100-mL bags of normal saline.
Given the recent outbreak of coronavirus and its impact on manufacturing in China, South Korea, and potentially other significant geographic locations, we are reminded that an available plan for organizing any medical center can assist with providing a clear course of action when faced with uncertainties.
Although the process may seem obvious, the answer is not as easy as “find more” or “find something different.” Reasons for this are complicated but involve identifying shortages before becoming critical, allocating to the most in need applications, and identifying alternate supplies that quickly become scarce as institutions nationwide scramble to procure these to fill in their shortfalls.
We decided the best approach to make this process as simple as possible was the creation of three workflows. The initial workflow outlines the series of steps our Chair of the Executive Committee of the Medical Staff will take to identify expert opinion on the feasibility of alternatives and rationing current and future levels. The second outlines the steps our pharmacy department will take in validating a shortage, determining current levels and burn rate, and reporting to the Executive Committee of the Medical Staff Chair. The third outlines these steps for our logistics department regarding supplies.
From a practical standpoint, the execution of these plans may be difficult. Notably, when allocation becomes necessary, central distribution has been a central tenant of our plan in order to limit waste and unnecessary consumption. This required the deployment of logistics supply techs throughout the institution to collect LR bags and restock with PlasmaLyte. The LR bags were then taken to central supply with a robust inventory maintained in the main operating room for use throughout the hospital when PlasmaLyte or normal saline was contraindicated. The minibags of normal saline were repurposed to the main pharmacy for distribution to clinicians as needed and to allow pharmacy to continue using for medication delivery. This plan needed to be effectively communicated as well, which was done through email and direct communication to department chairs.
During the roughly 3-month period this plan was in effect, there were no adverse patient outcomes or provider complaints related to accessibility of intravenous fluids. Based on our experience, we would recommend other institutions consider the proactive creation of a similar process especially given the coronavirus outbreak and its possible effects on medical and pharmaceutical manufacturers.
Acknowledgements
None.
Contributor Information
CAPT John A Hodgson, Department of Anesthesiology, Walter Reed National Military Medical Center, Bethesda, MD 20889, USA.
Dr. Christopher Spevak, Department of Anesthesiology, Walter Reed National Military Medical Center, Bethesda, MD 20889, USA.
FUNDING
None declared.
CONFLICT OF INTEREST STATEMENT
None declared.