This appeared last week:
Patients told to drink water as hospitals ration IV drips
By Henrietta Cook and Jewel Topsfield
August 17, 2024 — 5.00am
Victorian hospitals have been urged to ration intravenous fluids by getting patients to drink water, scaling back the use of drips during surgeries and administering medications orally after warnings about a global shortage of saline.
An internal Victorian Department of Health document – sent to hospital chief executives, directors of medical and surgical units, nursing and pharmacy directors and Ambulance Victoria – calls on health services to conserve 14 intravenous fluid products at risk of shortages.
“Efforts to conserve fluids need to increase to enable supply to meet demand,” the August 7 document reads.
“It is critical that all IV fluids are used judiciously.”
The warning comes after reports of a global shortage of saline IV supplies. The Victorian government and the Australian Medical Association stressed that the situation was not dire or a risk to surgeries and patient care.
The association’s Victorian branch president, Dr Jill Tomlinson, said Victorians should be “alert but not alarmed”.
“We haven’t had any elective surgeries cancelled,” she said.
“It is true to say that there are shortages and that is influencing how we do things, but it is not directly impacting patient outcomes.”
The advice comes as Australian health ministers agreed on Friday to share intravenous fluid supplies, which are used in almost all surgeries, to hydrate patients and administer medication directly into the bloodstream.
Federal Health Minister Mark Butler met health ministers to co-ordinate a response to Australia’s declining supplies of IV fluids, including sharing data on usage and supply and helping local manufacturers keep up with demand.
The Therapeutic Goods Administration has said the shortages are due to global supply limitations, unexpected increases in demand, and manufacturing issues.
The state’s health services have been told to convene teams to monitor and manage intravenous fluids “due to the increasing criticality of the shortage”, according to the Victorian Department of Health document, which was labelled “sensitive”.
It said where clinically appropriate, healthcare workers should consider alternatives such as fluid replacement via the mouth or tubes through the nose and into the stomach.
Medication can also be administered via the mouth, beneath the skin or into muscles where appropriate. Other conservation strategies detailed in the document include limiting “routine administration of IV fluids to patients undergoing day surgery” and minimising excessive fasting before surgery to reduce the need for fluid replacement.
A senior clinician at a Melbourne hospital, who did not want to be named because he was not authorised to speak publicly, said IV fluids had been used too liberally by hospitals over many decades.
“I would say half the patients on the surgical ward don’t need it,” he said.
He said healthcare workers at his hospital had been rationing IV fluids in the past month by encouraging patients to drink cups of water or other fluids.
The Royal Melbourne Hospital recently sent a message to staff about “significant interruptions to our supply of intravenous fluid bags”.
It said all health services were required to reduce the amount of IV fluids they used by 20 per cent to enable supply to meet demand.
“We ask that all staff use IV fluids judiciously and where clinically appropriate,” the notice read.
The hospital did not respond to questions from this masthead, referring the matter to the state Health Department.
An Allan government spokesman said Victoria had not been affected at this stage and there had been no disruptions to patient care.
“The department is actively supporting health services to conserve and monitor available stock, amid ongoing discussions with the main suppliers,” he said.
There is only one factory in Australia that is manufacturing IV fluids onshore – Baxter Healthcare’s Toongabbie factory in Sydney’s west.
A Baxter spokesman said the factory was “operating at historical volumes and full capacity to help meet the rising demand”.
Professor Nial Wheate, a medicines scientist from Macquarie University, said the shortage of IV fluid demonstrated that Australia was overly reliant on overseas manufacturers.
“There should definitely be more of a domestic and government-backed industry in Australia for saline and, I would argue, any types of medicines,” Wheate said.
“We are too reliant and when we cannot get medicines it is putting Australian lives at risk.”
Doctors at Northern Health, one of Victoria’s largest health services, were last month told to review prescribed IV infusions and switch to an alternative as soon as clinically possible.
“We are experiencing national stock shortages with sodium chloride 0.9% 500mL intravenous bags with disruption to supply anticipated to continue for the remainder of 2024,” staff were told in an email on July 17.
A spokesman for Northern Health said it was confident of its supply for the coming weeks, and it had not had to reduce any procedures.
The shortage has been more of a problem in NSW, where there have been reports of patients having to stay in hospital for longer following surgery because little or no IV fluid was administered to them, leading to dehydration and hypotension.
The AMA’s national president, Professor Steve Robson, said NSW – which has the biggest healthcare system in Australia – was facing larger logistical challenges than other states.
“We are getting no sense whatsoever of any particular problems in Victoria and Queensland and there seem to be plenty of fluids in Tasmania,” he said.
“I think a big part of it is caution at the moment. Because of uncertainty about supply, people are doing everything they can to preserve IV fluids at the moment and that’s a very reasonable precaution in the circumstances. They’re probably stockpiling as well – we saw the same thing with toilet paper during the pandemic.”
Robson said he commended the Commonwealth and state health ministers for establishing a taskforce to deal with the issue.
With Lachlan Abbott
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Honestly,
Monty Python could not have made this up! More seriously just how did this
happen and what odds do you give of the population ever knowing the why and who
was to blame. maybe the culprits could forma company and start manufacturing fluids. We know there is a market!!!!
While I live
and breath I plan to publish anything I can find out about this travesty! That the shortage is apparently global is astonishing! I wonder how things are in North Korea?
Any tips
/ insights much appreciated! A prize is on offer for identifying the next global stuff-up!
David.
1 comment:
David, we both know there is no such thing as a health beaurocrate, only beaurocrates. They don't get fired, just recycled. It is, I agree, a complete fudgecake. Could not run a bath and should not be anywhere near a complicated supply chain
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