Fluid Stewardship and Drug Shortages

“Salt and water shape the very foundation of life… Water and electrolytes may seem like simple components but their role in the symphony of life is nothing less than remarkable”, said John Armitstead introducing the Fresenius Kabi satellite symposium “IV fluid stewardship and why it matters”. As System Director of Pharmacy, Lee Health, Florida he is keenly aware of the daily challenge of tackling drug shortages. Intravenous fluids, including electrolytes and nutrition solutions represent one of the top five categories of drugs that are commonly in short supply, he noted. Shortages have been a constant feature for the past decade such that “drug shortages are a daily process – something that we need to manage as part of our pharmacy practice”, he said.

At first sight, large volume IV fluids are such simple products that manufacturing and supply problems might not be expected but in reality, a number of factors have impacts on the supply chain. These include fewer suppliers and lack of redundancy in the supply chain, just-in-time inventory management, extreme weather events and natural disasters. Just-in-time inventory practices work well until there is an insult to the system and then shortages can occur. An unintended consequence of the establishment of Group Purchasing Organizations (GPOs) is that some manufacturers may have been driven out of the marketplace, acknowledged Mr. Armitstead

Extreme weather events such as hurricanes, tornadoes and flooding can affect the pharmaceutical supply chain, Mr. Armitstead recalls the impact of Hurricane Maria – a category 5 hurricane that hit Puerto Rico in September 2017.

Managing IV fluid shortages

When IV fluid shortages occur, the pharmacy service needs to implement strategies to manage and conserve the available supplies, explained Mr. Armitstead. Such measures can include using IV push (bolus) dosing where possible, converting IV to oral dosing when feasible and sound IV fluid stewardship. The American Society for Health-System Pharmacists (ASHP) maintains a drug shortages database and has helpful factsheets on the management of shortage situations, he added

Getting started with fluid stewardship

A useful first step in establishing a fluid stewardship program could be to conduct medication use evaluations on IV fluids, suggested Mr. Armitstead. Medication use evaluations commonly focus on “therapeutic drugs” but “we should also take a look at some of our use of IV fluids and really study that use and look for appropriate prescribing and administration of those agents in our environments”, he said.

Based on a presentation given by Mr. John A. Armitstead at a Fresenius Kabi satellite symposium held at the ASHP Midyear Clinical Meeting 3-7th December 2023.

 

About John A. Armitstead

John A. Armitstead is System Director of Pharmacy Services, Lee Health, Fort Myers, Estero and Cape Coral, Florida. John obtained an MS Degree in Hospital and Clinical Pharmacy from Ohio State University and completed a Pharmacy Residency at Riverside Methodist Hospitals in Columbus, Ohio. He received a Bachelor of Science Degree in Pharmacy from Ohio Northern University, Ada, Ohio. He was Certified as a Pharmacy Executive Leader (CPEL) by the ASHP in 2023

He is a Fellow of the American Society of Health-System Pharmacists and Kentucky Society of Health-System Pharmacists. John is a Past President of the American Society of Health-System Pharmacists, the Ohio Society of Health-System Pharmacists and the Kentucky Society of Health-System Pharmacists. He has served as Chair of the House of Delegates for the Florida Society of Health-System Pharmacists. He has served as a Board Member of these societies for more than 25 years.

John is a 2016 Distinguished Alumnus from Ohio Northern University, a winner of the 2005 Clifton J. Latiolais Award and the Jack L. Beal Post-Baccalaureate Award from Ohio State University in 2015, Pharmacist of the Year in Kentucky in 2004, Preceptor of the Year at the University of Kentucky in 2001 and Lee Health in 2014 as well as President’s Circle Awards Winner from Lee Health in 2016 and 2018. In 2020 John was awarded the ASHP Board of Directors Award for Distinguished Leadership and in 2023 John received the FSHP Anna Thiel Meritorious Service Award.

 

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