Managing Shortages of Small-Volume Parenteral Solutions

October 26, 2017

Strategies for Conserving Vital Medications in Short Supply in Aftermath of Hurricane Maria.

ASHP and the University of Utah Drug Information Service have developed a fact sheet that provides an outline of potential actions for health-care organizations to keep in mind when managing shortages of small-volume parenteral solutions (SVPs).

SVPs are solutions of 100 mL or less that are used in nearly all hospitals to dilute intravenous medications. Sporadic shortages of SVPs - in this case due to hurricane-related damage to pharmaceutical manufacturing plants in Puerto Rico - have become a serious problem for hospitals, health-care systems, and ambulatory care infusion centers.

Douglas Scheckelhoff, ASHP Senior Vice President for Practice Advancement at ASHP said that shortages of SVPs can have a significant impact on the safety and quality of patient care in hospitals and health systems. “Our recommendations will help pharmacists and other health-care providers determine the best course of action to conserve this vital product and mitigate the potential harm to patients,” Scheckelhoff said.

The fact sheet proposes options that health-care organizations can take to conserve products such as clinically appropriate alternative methods of administration including: oral dosage forms, intramuscular injections, or subcutaneous injections; changing electronic health records to allow flexibility to use either dextrose or saline for drugs compatible with both solutions; switching to the use of saline flush syringes, 500 mL bags, or 1 L bags to start intravenous lines; or compounding  medications that can be administered via IV push in ready-to-administer concentrations.

In addition, it advises health-care organizations to evaluate their current supply of SVPs and redeploy product to the areas of greatest need, transition to the use of premixed solutions, and reflect product changes in all pharmacy automation.

The document points out that imported product - the FDA recently allowed Baxter to import SVPs from the manufacturer’s facility in Ireland - is available for purchase as supplies become available.