This week we are addressing the ongoing shortage of sterile water for injection and sodium chloride for injection.

Very few drug shortages have such a widespread impact on patient care as this one. This has such a broad impact because of how widely used these products are. In this post we address steps you can take to mitigate the effect on your facility.

At this point you have either heard about, or have been directly impacted by the ongoing shortage of sterile water for injection and sodium chloride for injection. This is not a new shortage, but an ongoing one. Both products have been featured on our Drug Shortage Updates (both December and February).

Although the ongoing shortage is very challenging for pharmacies, it’s even more difficult for ambulatory surgery centers and long-term care facilities who don’t have an in-house pharmacy. There are steps you can take to minimize the direct impact but remember that changing processes often introduces other patient safety risks. It’s important to think through alternative approaches, provide staff education, and continually monitor for full compliance.

General steps you can take to lessen the impact of drug shortages:

1. Determine the cause and status of the shortage: Use the Food and Drug Administration’s Drug Shortages List and the American Society of Health-System Pharmacists list of Current Drug Shortages to help you identify what is causing the shortage and when it may be resolved.
2. Communicate the shortage with your entire team: The earlier everyone is aware, the better your chances of discussing and implementing alternate plans.
3. Order as early as possible. Even if you don’t get it right away, you will be in the queue when the drug becomes available.
4. Consider alternatives: Being proactive could allow you to make a change before running out of the preferred product.

These steps are a starting point and are more difficult to execute with some products. As mentioned earlier, since we use sterile water and normal saline for many different reasons, one size will not fit all. So, what then? There are some steps you can take specifically for these products. I recommend involving your consultant pharmacist ahead of time. Your pharmacist can help answer questions specific to your situation and guide you on patient safety issues that often arise when using work-around solutions.

Specific steps you can take to lessen the impact of these shortages:

1. Consider ways to conserve: Reserve sterile water for drugs that cannot be reconstituted with other diluents. Your pharmacist can help you make this determination. If you need help, don’t hesitate to reach out to us.
2. Consider stocking products that don’t require dilution. There are some commercially available products that don’t require further mixing.
3. Consider using Ryanodex instead of other dantrolene preparations. Ryanodex vials only require 5mL of sterile water for injection, while other dantrolene products require 60mL per vial (up to 36 vials). You can use the extra sterile water for other needs.
4. Consider diluting medications with alternative sterile diluents such as D5W. Check the medication package insert and verify with your pharmacist ahead of time to make sure this is allowed.

The fifth step would be to remember to keep safe injection practices and patient safety in the forefront of your planning when making any decisions. There are many tempting ideas, like using a large bag of normal saline as the source of flushes for multiple patients. For several reasons, this is a dangerous idea and should not be done.

I know the above steps don’t solve every occurrence in every facility, but hopefully they are a launching point to minimize the impact of the shortages. If you have a specific concern or situation that was not mentioned above, reach out to your pharmacist for specific guidance. If you don’t have a pharmacy consultant or still have questions, contact us and we would be happy to help you.

The Consultant Pharmacists at OctariusRx provide guidance on safe medication management, survey readiness and cost savings to ambulatory healthcare facilities/surgery centers, senior care facilities and pharmacies. We also help individual patients optimize their medications to improve their quality of life and save money. Contact us for assistance.