Searching for alternative processes, products before demand peaks

When a crisis or disaster strikes a manufacturing production plant or product distribution facility the demand for products affected most likely spikes in reaction. When the products involve patients of any kind — particularly high-risk patients that require IV and pharmaceutical solutions for treatment and recovery, healthcare providers must have alternative plans and products available.

Several supply chain executives shared accessible options with Healthcare Purchasing News.

“During the course of a shortage, one of the most viable conservation strategies we have advocated for was converting appropriate medications to an IV Push strategy,” said Vincent Jackson, Vice President, Pharmacy Services Group, HealthTrust. “Based on clinical literature, certain medications benefit from the ability of either being infused in a solution or being able to be administered rapidly via IV push. This IV Push approach conserves significant amounts of IV solutions while maintaining quality care for the patient.”

Alternative products may be needed but Stephanne Hale, Director, Clinical Solutions, Vizient, warns providers not to overlook conservation strategies, which can “reduce waste when supply is adequate and sustain operations and provide patient care during shortage situations,” she advised.

Hale recommends the following useful conservation strategies for IV and pharma solutions:

• Deliver IV fluid based on patient need. When maintenance fluid is required, consider an empirically proven weight based fluid maintenance protocols. This method may result in a smaller total volume infused than a standard infusion rate approach. Additionally, the need for other forms of fluid administration, such as fluid resuscitation, fluid replacement and redistribution should be assessed and administered until the patient condition is stable and discontinued when no longer needed.
• Oral intake is recommended for medically stable patients. A thorough patient assessment must be performed and the physician must provide an order. Consult a pharmacist for a clinically equivalent oral conversion of any remaining IV doses. If an oral form of a medication is unavailable, consider alternative equivalent forms when feasible such as IV push, intramuscular, subcutaneous, or intra nasal doses. Again, this requires a physician order and a pharmacist should be consulted.
• Utilize smaller volume fluid bags whenever possible and discontinue the patient IV as soon possible, with a physician order, if no longer needed.

Hale insists that alternative products and conservation strategies should be part of every provider’s normal supply strategy and not just in response to a crisis event.

Thomas Lubotsky, a former Chief Supply Chain Officer at a leading Midwestern integrated delivery network and senior healthcare supply chain industry observer, reluctantly points to rationing among the more critically ill and trauma patients as one alternative method to deploy during episodes of severe IV and pharma solution shortages, which occurred in the aftermath of the hurricane.

“While not a preferred practice by any means, these desperate measures were deployed to create the safest environment for treating patients throughout the healthcare system,” he said. “There really are no alternative products to consider — ruling out the ‘Gatorade’ alternative approach utilized by some providers — however, utilizing different sized IV and pharma solutions bags from the manufacturer was an alternative delivery method deployed to best provide the needed product to the patient bedside. Converting lower unit size bags to larger unit bags was administered by the pharmacy departments to best meet the appropriate patient care levels.” 

Because “the needs of every hospital and health system are different,” Leigh Nickens, Director of Marketing, Fluid Therapy and Injectable Drugs, B. Braun Medical Inc., recommends Supply Chain pursue clinical input fast, first and foremost within their respective organizations.

“Healthcare organizations should consult with their clinical and formulary teams to determine and develop best-practice delivery methods,” she insisted. “B. Braun recommends putting a pre-approved plan in place and communicating it broadly within the whole organization.”

It’s never too late to assess supplier performance, Nickens added.

“Keep in mind that the aftermath of a shortage is the best time to prepare for the future,” she said. “Evaluate whether the organization’s solutions partners have been willing and able to take a lead role in planning to help meet future supply needs.”

Michael Moloney, Premier Inc.’s Group Vice President of Integrated Pharmacy, doesn’t believe alternative products remain the only option.

“Innovative delivery methods are key to solving this issue, and that requires providers to consider purchasing strategies that leverage scale and demand aggregation to drive competition that fosters alternative products,” Moloney noted. “We know that a competitive process for price negotiations with pharmaceutical manufacturers can make a tremendous difference for hospitals and health systems, and we support our members with this in multiple ways. Another method providers should consider is ensuring they have value-based contracts in place with manufacturers that demonstrate product ROI based on patient outcomes.”