Area hospitals deal with shortages

COLDWATER - Medical facilities have had to work around shortages of drugs and other supplies after last year's hurricanes, and though representatives of local hospitals believe supply chains are slowly recovering, this year's severe flu season hasn't helped matters.

"We're hanging in there. It's just definitely a challenge," said Nathan Burtch, director of support services at Mercer County Community Hospital. "We're having to get a little creative trying to source everything we need."

Burtch has created a spreadsheet listing different supplies and drugs, how much is used in the hospital on an average day and how many days' supply is on hand. He updates it and sends it to hospital staff daily, so employees can plan treatment accordingly. One item on the list is small-volume intravenous saline bags.

Those bags are often used to diffuse medicines into a patient's bloodstream and have encountered supply issues even before Hurricane Maria's impact on the supply of medical products, according to a Food and Drug Administration news release. However, the hurricane in Puerto Rico worsened the situation, and the flu season has created increased demand for saline and other products.

According to Burtch's count, Community Hospital uses about 68 bags of saline per day, based on a six-month average. Due to supply shortages, hospitals have looked for ways to conserve their supplies.

"Small-volume IV bags that we mix antibiotics and stuff in, those were on shortage as well so we looked to see what we could safely give by IV push instead of adding it to a bag and administering it over 30 minutes," said Shelly Ross, Community Hospital's pharmacy director.

An IV push is when medicine is directly inserted into an IV line and is pushed into the patient's bloodstream over several minutes by a practitioner, rather than by using an IV bag with a pump to diffuse the medicine more slowly. Cindy Liette, Community Hospital's vice president of patient care services and chief nursing officer, said the method is perfectly safe and is within the recommended rate of administration for certain drugs.

IV pushing and switching to alternative treatments or solution fluids helps conserve short supplies during a worse-than-normal flu season. Liette said that during the 2016-2017 flu season from November to February, Mercer Health conducted 511 flu tests. This season, they've performed 1,160 tests, and those test kits are also in short supply.

"Our inpatient census has been up substantially with influenza, both for adults and kids. We've definitely seen an increase in our pediatric admissions," Liette said.

Lana Hinders, director of emergency services at Joint Township District Memorial Hospital, said her department has not experienced flu kit shortages because they've switched to an alternative method.

Officials from both Mercer Health and Grand Lake Health System have said they've faced no price hikes despite shortages, thanks to protections in their group-purchasing organization contracts. Additionally, Mercer Health representatives said they believed the situation is slowly improving, noting that shortages aren't new in health care.

"Before the hurricane, flu season or any of that, there's been lots of drugs that have been in short supply," Ross said. "It really hits hard if there's a certain drug and there's only one manufacturer of it, and then if that manufacturer has problems or delays, then all of a sudden you can't get that drug, versus if there's another drug and there might be six different manufacturers of it. If one has a problem, you just shift to another manufacturer."

Organizations such as the FDA and the Ohio Hospital Association have been looking at the industry's history of shortages and are trying to address the causes, as well as mitigate shortages when they happen. After thorough testing, the FDA recently extended the expiration date on certain prepackaged emergency drugs whose manufacturer was experiencing delays. Still, unforeseen problems will always occur.

"One of the things that compounded the hurricane problem was one of the big manufacturers was closing a plant in one area and transferring it to another area, and the new area they were transferring it to was Houston," Ross said.

When Hurricane Harvey struck the Houston area, that manufacturer's plans were severely delayed.

"Shortages are a constant problem," said Tyler Kroeger, a pharmacy specialist at JTDMH. "I know over in Lima they've had some issues with Tamiflu, which is an antiviral medication used to treat the flu. There has been shortages within the past couple of weeks that I've heard of with that particular medication, but we're doing OK, trying to get by."

Despite the challenges, Ross said Community Hospital hasn't had any issues getting the flu vaccine this year or the antiviral drugs used to fight influenza. Susan Niemeyer, a JTDMH purchasing agent, wrote in an email that the hospital has reserved inventory of vaccine and antiviral supplies.

Nicole Pleiman, a Community Hospital infection prevention specialist, said it wasn't too late for people to get vaccinated and encouraged people to do so because they continue to see new flu cases.

"More of our hospitalizations have not gotten the vaccine than those that have," Pleiman said.  

Liette noted that hospitals have been working together during this shortage. If Mercer Health ever faced an extreme shortage, she said, they would call a neighboring hospital and ask to borrow supplies that they would pay for, and they'd offer the same for another hospital.

"Everybody just wants what's best for the patients," Pleiman agreed.