Background

As a result of Hurricane Helene, facility and site operations at the Baxter International plant (a major manufacturer of IV and peritoneal dialysis solutions) in North Carolina have been disrupted. Per the Department of Homeland Security's Cybersecurity and Infrastructure Security Agency, the Baxter Healthcare Corporation's parent company is increasing operations at other facilities to augment the loss of IV production capacity. It should be noted that Baxter is currently allocating their supply.​

California Supply Chain and Capabilities

Although some of California's major healthcare systems procure IV bags from other manufacturers, CDPH anticipates significant impact in California due to the Baxter North Carolina plant shutdown and other concerns impacting the supply chain. Additionally, California does not stockpile IV bags either at the California Department of Public Health (CDPH) or at the Emergency Medical Services Authority. However, CDPH is working with the Regional Disaster Medical Health Specialists (RDMHSs) and Medical Health Operational Area Coordinators (MHOAC) to identify supplies within the Mutual Aid Region and to collect resource request from individual facilities that are in immediate need of product. Facilities should work with their local Health Care Coalition to determine if products can be shared across facilities.

The RDMHSs will intermittently continue to contact facilities to obtain information about their supply levels. It is important for facilities to respond to these inquiries timely to ensure the State has accurate information about supply availability across the state.

CDPH Recommendations

CDPH encourages facilities to prepare and organize themselves to manage their needs. Planning for the supply chain issues includes:

• Review your emergency preparedness plan and implement policies to address the potential scarcity of IV fluids.
• Assess your facility's IV fluid stock, utilization patterns, and projected needs for 'business as usual'.
• If affected by an allocation reduction from Baxter or other manufacturers, collaborate immediately with clinical care teams and managers to adopt strategies to conserve, communicate and train, track utilization and outcomes on at least a daily basis, adapt/respond promptly to problems, seek assistance from MHOAC/RDMHS when approaching critical supply levels.
• Pursue alternative sources of IV fluid procurements via existing contracts or resources announced by Food and Drug Administration (FDA), state officials, and Baxter.
• Mitigation Strategies may include those outlined by respected organizations such as American Society of Health System Pharmacists (ASHP), American Hospital Association, Emergency Care Research Institute (ECRI), and IV fluid manufacturers including Baxter.

• For facilities able to compound IV solution, determine feasibility of compounding IV solution within the facility.
  

Product Management and Conservation Actions

Below are the product management and conservation actions recommended by Baxter's Medical Affairs team:

• Evaluate Inventory
• Review your current stock levels and expiration dates.
• Prioritize the use of fluids that are most essential for patient care.
• Evaluate Clinical Needs
• Work with clinical teams to identify which patients are in most urgent need of impacted IV solutions.
• Consider reevaluating protocols for fluid administration to prevent unnecessary usage.
• Identify Alternative Sources of Solutions and Medications
• Recommend the use of alternative IV fluids or solutions when appropriate.
• Consider using smaller volumes or concentrated forms of fluids, based on clinical guidelines.
• Optimize Fluid Management
• Implement evidence-based fluid management protocols to optimize IV fluid administration and minimize waste.
• Assess Pharmacy Operational Strategies
• Consider transitioning to commercially manufactured premix medications, if available.
• Engage Clinical Teams
• Provide education and training to healthcare providers on managing fluid restrictions, medication and therapeutic changes and the potential risks.
• Document and Monitor
• Maintain thorough documentation of impacted fluid and medication usage, patient needs, and any adverse effects or shortages encountered.
  

Questions

If you need assistance with locating IV supplies, please contact your MHOAC/RDMHS.

If you have any questions regarding the content of this AFL, please contact your respective district office.

Sincerely,

Original signed by Chelsea Driscoll

Chelsea Driscoll

Public Policy and Prevention Division Chief

Resources:

• Medical Product Shortages and Scarce Resources | ASPR TRACIE (hhs.gov)
• ASHP Suggestion for Management and Conservation pf IV Fluid
• Baxter Hurricane Helene Updates
• Baxter Suggestions for Management and Conservation
• Letter to Health Care Leaders and Stakeholders on Impacts of Hurricane Helene from Secretary Becerra | HHS.gov