A Universal Solution to Small Volume Parenteral Solution Shortages

Vial2Bag Advanced™ the Universal Point-of-care Solution


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. Facilities are calling upon medication distribution wisdom gained from lessons of the past to conserve and preserve precious IV fluid bag supplies ASHP’s SVP Shortage recommendations focuses on conservation strategies including transitioning to use of point-of-care devices for SVP infusions. Recent research in the Journal of Pharmacy Practice compared use of a point-of-care device, Vial2Bag, 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 systems like Vial2Bag. Additionally, ASHP recommends reviewing the stock of SVPs and compatibility with mix-on-demand supplies. Except for Vial2Bag Advanced, 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 true 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 Advanced uniquely works with any brand IV fluid bag and is needle-free, an ideal 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 Vial2Bagfor 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 delivery.

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, decreasing risk of contamination, 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.