With the flu season upon us, a new emergency looms as U.S. Hospitals and clinics are facing rampant IV fluid shortages, outlined last week on ASHP’s drug shortage website. Small volume parenteral solutions (SVPs) are the foundation of IV compounding for hundreds of medications that require dilution before administration. The current SVP solutions shortage is a result of increased demand and affects multiple IV bag manufacturers, leaving clinicians with an ominous sense of déjà vu, recalling the 2017-2018 IV fluid shortage disaster after Hurricane Maria. ASHP’s Fluid Shortages – Suggestions for Management and Conservation focuses on conservation strategies and recommends reviewing inventory of IV bags compatible with devices such as Vial2Bag® Admixture Device . Recent research in the Journal of Pharmacy Practice compared use of a point-of-care device, Vial2Bag® Admixture Device , with ready-to-use and locally compounding infusions**. The authors reported more than $2 Million in cost avoidance and over 40,000 fewer IV room compounded products and discussed the supply chain disruptions alleviated by a flexible point-of-care system. April 2021 State of Pharmacy Compounding by Pharmacy Purchasing & Products reported that only 64% of facilities have embraced a point-of-care medication distribution model but the current IV fluid shortage is certain to propel this commonsense, cost-saving conservation strategy.
ASHP’s Small-Volume Parenteral Solutions Shortages recommends conservation strategies, consideration of IV push, use of premade infusions when available, and conversion to point-of-care devices like Vial2Bag® Admixture Device . Additionally, ASHP recommends reviewing the stock of SVPs and compatibility with mix-on-demand supplies. Except for Vial2Bag® Admixture Device , all other admixture devices are designed to work with a specific brand of IV fluid bag, restricting the user to that brand bag and compatibility matters. Vial2Bag Advanced® is a universal* solution compatible with all brand IV bags from 50mL to 250mL. The supply chain “domino effect” has already expanded beyond IV Infusions with IV push supplies, like vials of 0.9% Sodium Chloride and Sterile Water for Injection needed for many IV push drugs, also currently in short supply. Also expected to be impacted are the supplies of premade drug infusions, historically in short supply. The 2018 Third Consensus Development Conference on the Safety of Intravenous Drug Delivery Systems reported that 97% of survey respondents have experienced supply chain disruptions on manufactured ready-to-use infusions. It is hard to imagine worse than 97% supply disruptions, but the current IV bag shortage is expected to worsen the ready-to-use and premade infusion supply challenges.
Maximizing point-of-care admixture can provide supply flexibility while reducing cost and safety events and improving workflow efficiencies. Vial2Bag® Admixture Device uniquely works with any brand IV fluid bag* and is needle-free, a preferred point-of-care admixture solution. Use of point-of-care medication preparation was evaluated in a 2019 study reviewing the cost, workflow and safety of implementing Vial2Bag® Admixture Device** for point-of-care admixture compared to local pharmacy compounding and purchase of ready-to-use infusions. The large tertiary academic medical center in Boston reported an estimated yearly cost avoidance of $2,295,261 and 41,082 yearly sterile product room units avoided.
Flexible Medication Distribution Strategies Mitigate Supply Chain Disruptions
IV fluid shortages are only one part of a chronic pharmacy supply nightmare. A CBS News article last month reviewed the drug shortage struggle U.S. hospitals are facing stating “The FDA currently lists 109 drugs in short supply nationally. The American Medical Association is calling the shortage an “urgent public health crisis” that “threatens patient care and safety.” Whether it is a Hurricane, changes in trade restrictions, a pandemic, complicated drug market forces, manufacturing challenges, or raw material shortages, supply disruptions in medicine are an unfortunate reality. A wise approach to navigating turbulent supply challenges includes adopting flexible medication distribution strategies including use of point-of-care medication admixture devices. Using point-of-care admixture devices can provide cost savings, reduce drug and IV fluid waste, improve pharmacy workflow efficiency, and improve timeliness of medication delivery1.
The benefits of maximizing use of a point-of-care device as part of an efficient medication distribution strategy can be immediate and long term. Point-of-care medication distribution with a universal* admixture device can minimize the impact of supply disruptions and provide a method for IV fluid conservation without valuable pharmacy compounding time and Beyond-Use-Dating requirements that can result in drug and IV fluid waste***. Point-of-care medication distribution provides convenience and safety at reduced cost and with a consistent supply. Point-of-care medication practices allow for the medication to be prepared as close to the time of administration as possible, improving medication delivery efficiency, and ensuring the medication is there when the nurse and the patient need it. Point-of-care medication distribution is a recommended IV fluid conservation strategy and implementing a Universal admixture device provides flexibility in the face of turbulent supplies with the added benefits of cost savings, workflow efficiency and reduced drug and IV fluid waste. The IV fluid supply was steady for a couple years following Hurricane Maria, but the current shortage reminds us that SVPs are not immune to supply disruption and because they are ubiquitous in pharmacy, their disappearance is always massively disruptive.
*Vial2Bag Advanced® 20mm Admixture Device is compatible with manufacturers’ IV bags in 50mL, 100mL, or 250mL that contain an ISO standard IV port; ISO 8536-4 standard IV spike
**Vial2Bag® admixture device and Vial2Bag Advanced® admixture device are separate products; West’s Vial2Bag Advanced® admixture device replaced the Vial2Bag® admixture device in commerce.
***Beyond-use dating (BUD) requirements may not apply if drug vial remains unpunctured. Always consult USP <797> and facility policy for applicable BUD requirements.
1. Tran LK, Anger KE, Dell’Orfano H, Rocchio MA, Szumita PM. Evaluation of Cost,
Workflow, and Safety of Implementing a Vial Transfer Device for Ready-to-Mix Drugs
at an Academic Medical Center. J Pharm Pract. 2020 Jul 8:897190020938195. doi:
10.1177/0897190020938195. Epubahead of print. PMID: 32638650.
Prescription Use Only.
The Vial2Bag Advanced® 20mm admixture device is 510(k) cleared by the United States Food and Drug Administration (FDA). The use of the Vial2Bag Advanced® 20mm admixture device should not be interpreted as modifying, extending, or superseding a drug manufacturer’s labeling recommendations for storage and expiration dating, unless otherwise limited by USP <797> compounding standards. Refer to drug manufacturer’s labeling and use instructions for recommendations, USP <797>, and applicable institution policy for shelf life and sterility information of reconstituted product and admixture device compatibility. The Vial2Bag Advanced® 20mm admixture device is not compatible for use with all drug products. Do not use the Vial2Bag Advanced® 20mm admixture device with lipids. Failure to follow the instructions provided may result in inadequate medication reconstitution, dilution, and/or transfer, possibly leading to overdose or underdose and/or delay in therapy. Products shown are for INFORMATION purposes only and may not be approved for marketing in specific regions. Important product and safety information and warnings at: https://www.westpharma.com/products/vial-adapter-systems/vial2bag-advanced.
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