As has been reported extensively, Hurricane Maria in September 2017 temporarily knocked out production of IV fluid bags in Puerto Rico, which produces 44% of the bags used in the U.S. While the shortage of 50- and 100-ml bags has abated somewhat, shortages continue for larger 500- to 1000-ml bags. In fact, U.S. hospitals for the better part of a decade have faced reoccurring shortages of IV fluids for a variety of reasons.
Now, a team at Brigham & Women’s Hospital has developed a series of timed steps that providers can take to ensure that ED patients with mild dehydration can rehydrate by drinking fluids rather than having them injected through an IV catheter. The oral rehydration protocol is included in the hospital’ electronic medical record and order-entry system, streamlining the process.
In
this New England Journal of Medicine article describing the protocol, the authors wrote, “To ensure implementation of our protocol, providers were sent an email message by hospital leadership detailing the IV-fluid shortage and the oral rehydration protocol. ED nursing leaders trained nurses and ED technicians and posted flyers throughout the ED. We also provided additional training and reminders about the oral rehydration protocol to our faculty and residents.”
Like traditional IV use, the oral hydration strategy relies heavily on clinical judgment to determine which patients will benefit from its use. And, the authors note, “Patient and family participation is key to success” since patients are required to consume set amounts of fluids at periodic intervals, and usually rely on family members to time them.
“We share this protocol as a replicable model for other U.S. hospitals looking for strategies during the IV-fluid shortage,” the authors write. “Experience in low-resource settings worldwide has proven the efficacy of oral rehydration therapy, and vulnerabilities of the U.S. IV-fluid supply chain are expected to continue. We believe that widespread use of oral rehydration protocols would therefore be a rational practice change and a mainstream model for use in the United States even after the current IV-fluid shortage crisis ends.”