Published January 16, 2025
On Oct. 8, hundreds of Yale New Haven Health leaders were at a fiscal year 2025 kickoff event in Bridgeport when some were pulled aside for a separate meeting.
They discussed how to manage a looming IV fluid shortage – the result of Hurricane Helene flooding the Baxter International North Carolina plant that supplies most of YNHHS’ fluids. The next morning YNHHS activated its System Incident Management (SIM) structure, which has coordinated responses to COVID and other major events.
“We were having flashbacks to the pandemic when there was a shortage of PPE (personal protective equipment),” said SIM team member Jordan Swenson, manager, YNHHS Office of Emergency Preparedness. “We reviewed our disaster management after-action reports from the pandemic for measures that could help with the IV fluid shortage.”
The SIM team comprised representatives from Pharmacy, Corporate Supply Chain, Perioperative Services, the Emergency Department (ED), Nursing and providers. They developed strategies to conserve existing IV fluids, acquire more and find alternatives. One of the first steps was communicating the need to conserve.
“Nursing leaders said, ‘We’re all in this together. How can we fix this?’ That empowered a lot of nurses to get involved,” said Selina Nazzaro, RN, YNHHS Central Staffing Office nurse and chair-elect of Yale New Haven Hospital’s Nursing Professional Governance Coordinating Council.
Nursing leaders tapped frontline clinical nurses throughout YNHHS to help develop communications and best practices to promote fluid conservation. Pharmacy and providers collaborated to update Epic order sets and Care Signature pathways to promote IV fluid alternatives (such as oral hydration) when appropriate. Pharmacy also changed how certain medications are prepared and administered.
“Pharmacy has played an integral role in our success in dealing with the shortages,” said LeeAnn Miller, PharmD, vice president and chief pharmacy officer, YNHHS. “Pharmacy team members have led and supported efforts to reduce waste and optimize the use of alternatives.”
The ED and Perioperative Services, two of the biggest IV fluids users, immediately instituted numerous processes to reduce use by nearly 40 percent. Still, YNHHS needed to sustain its conservation efforts, since the shortages of IV fluids and sterile fluids commonly used for irrigation were expected to last several months.
In response, Pharmacy began producing its own sterile irrigation bags, which has allowed surgeries and other procedures to continue without delay or interruption in care. To solicit employees’ conservation ideas, Nursing created an online form that yielded nearly 90 suggestions. About half were implemented, including:
While departments throughout the health system were working to conserve, Corporate Supply Chain (CSC), continued seeking IV fluids from different sources and procuring alternative supplies.
CSC and Pharmacy worked with the Joint Data Analytics Team to create detailed online dashboards showing IV fluid inventories and use. These dashboards are similar to those developed during COVID but more detailed – showing fluid use and trends by delivery network, individual department and provider.
In late December, Baxter International announced that IV fluid manufacturing at its North Carolina plant should return to normal in the first quarter of 2025. Meanwhile, YNHHS continues to conserve without significantly impacting patient care and safety.
“I am continuously impressed by the expertise, creativity and dedication of our physicians and staff,” said Thomas Balcezak, MD, chief clinical officer, YNHHS. “As they did during COVID, people from many different roles and departments are collaborating to overcome significant challenges while keeping the focus on our patients.”
