NY Health: Conserve IV Fluids and Materials Due to Supply Chain Disruptions

October 9, 2024 DHDTC DAL#: 24 - 07 Supply Chain Disruption and Conservation Strategies Following Cl osure of Baxter Plant Supply Chain Disrupt ion and Conser vation Strategies Dear Chief Executive Of ficer s and Administrators: H ospitals and diagnostic and treatment cen ters including ambulatory surgery centers, end stage renal disease facilities and clinics rel y on intravenous (IV) fluids, mat erials, and end stage renal disease supplies to provide patient care. Recent supply chain di sruptions, including the closure of a ma jor IV solution and related suppli es manufacturing plant, have led to challenges i n maintaining steady access to thes e essential supplies. It is crucial for hospit als and diagnostic and treatment centers to adopt proactive strategies to conserve IV fluids, materials, and end stage renal supplies, ensuring that available stock is used effectively and efficiently. This direc tive outlines conservation strategies tailored specifically for hospitals and diagnostic and treatment centers. These strategies aim to optimize the use of IV fluids prio ritize critical situations and encourage the use of alternative treatment metho ds when appropriate. By implementing these measures, providers can maintain high standards of patient ca re while managing supply chain uncertainties. Through thoughtful conservation efforts, hospitals and diagnostic and treatment centers can help limit the impact of supply disruptions and ensure that critical resources are ava ilable when they are most needed. Conservation Strategies Immediately Begin to Inventory, Monitor, and T rack Usage: Implement systems to trac k the inventory of IV fluids, mat erials an d end stage renal suppli es at the system, provider, and department level, as well as the volume of IV fluids used per provider a nd per patient, ensuring appropriate utilization, and utiliz at ion of IV fluids mo st soon to expire. Da ta on cases where IV fluids are withheld should also be collected to refine future protocols. Limit surgeries or procedures that use IV fluids to those that ar e necessary for the preser vation of patient safety: Providers should r eserve IV fluids for important surgeries. Non - es sential elective surgeries and non - urgent procedures should be delayed. Limit Ro utine Use in Pre - Hospital Settings: Hospital and diagnostic and treatment center personnel should avoid starting IVs unless it is an ticipated that IV medication or fluid resuscitation will be required. Encourage providers to use clinical judgment when decidi ng whether to initiate IV acce ss in pre - hospital care and during other care episodes. Priorit ize Crit ical Uses: IV fluids should be reserved for patients in cri tical situations, such as severe dehydration or trauma, where alternative routes (o ral or enteral) are not viable. Regularly review

patient protocols to ensure that IV fluids are ad ministered only when absolutely necessary. For conscious and stable patients, promote oral hydra tion as a viable alternative to IV fluids. O ptimize IV Fluid Usage: In cases where smaller volumes a re sufficient, use smaller IV bags (e.g., 250 mL or 500 mL) to reduce waste and conserve stock. Administer the minimal necessary volume of IV fluids to stabilize patients before hospital trans port and consider limiting fluid volumes in non - critical cases. When diluting medications, use only the a mount of fluid necessary to ensure the medication’s stability and effectiveness. A lternative Routes for Medication Administration: Where clinically appropriate, consider administering medications intramuscularly (IM), subcutaneously (SQ), or by mouth (PO) instead of th rough an IV route. Thank you for your partnership. Please fo rward any questions regarding this gui dance to hospinfo@health.ny.gov. Sincerely, Stephanie Shulman, D rPH, MS Director, Division of Hospitals and Diagnostic & Treatment Cen ters