1. Garcia, Marie A. RN, OCN

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Over the past few years, our team of cancer treatment providers at Virginia Cancer Specialists, like other facilities across the U.S., has experienced intermittent shortages of IV bags, which we use to administer and dilute chemotherapy and pre-medications for our patients.

IV supply shortage; ... - Click to enlarge in new windowIV supply shortage; oncology. IV supply shortage; oncology

The bags, along with many other medical device products, are produced in Puerto Rico, which in September 2017, was devastated by a Category 4 hurricane-the first to hit the island in more than 8 decades. Puerto Rico produces more pharmaceuticals by dollar value than any other state in our country, so it is no surprise that the aftermath has been felt by many-perhaps most acutely among my colleagues and our patients well outside the devastation locally in Puerto Rico.


I've been able to turn the challenges that we faced into a learning experience. My goal now is to provide guidance and key considerations to shed some light on how others in the health care community can successfully deliver patient care during an ongoing product shortage.


1. Understand your supply chain.

Whether it be drugs, fluids, or supplies, you have to understand where your products come from and be able to recognize their source to ensure their safety. Our intimate knowledge of our most critical supplies allowed me and my team to begin planning for potential shortfalls early with our trusted vendors.


2. Know where to turn for guidance.

In the midst of the storm and in its aftermath, the FDA was keeping watch of the most critical life-saving and life-sustaining supplies needed by patients on and off the island. My team and I stayed in close communications with our colleagues, our vendors, and our industry association partners regularly, which helped us determine a path forward even before the FDA officially recommended the use of other types of pumps such as elastomeric pumps for chemotherapy and pre-meds. As our needs became more critical, we proactively worked with our elastomeric pump vendor to find a solution to ensure safe, effective patient care through the ongoing shortage. This included introducing new approaches to care using a disposable, portable infusion system, allowing us to minimize disruption to our facility and continue to care for our patients.


3. Weigh the convenience.

Change is often difficult and even more so in a health care setting in which time constraints abound and precision is critical for successful outcomes. It is no surprise that your colleagues may focus on the perceived tradeoffs when using a new product initially, but it is important to consider the long-term potential benefits. In introducing the new technology to solve the shortage, we also enjoyed the added benefit of time savings for our nurses who no longer needed to mix their own solutions. What's more, our vendor served as a partner, providing in-servicing and hands-on support to make our transition as simple as possible.


4. Account for variability.

While there have certainly been unexpected, positive aspects of this new technology, when you introduce a new product, there will always be time spent learning the product's nuances and adjusting to potentially different functionality. To preempt any disruptions to our patients, we proactively adjusted our infusion schedules to accommodate variability inherent in using something new.


5. Maintain communication with key stakeholders.

Many of our patients may not have even realized the supply constraint situation at hand, especially since most of the work we did to adopt substitute procedures was done behind the scenes. We communicated early and often with our physicians who were understandably concerned about ensuring their patients received their chemotherapy on time and properly prepared. While replacing one product for another had little impact on our patients, ensuring our physicians understood the importance of trying new methods for medication delivery was critical. They, with the rest of our staff, were able to proactively communicate directly with their patients who heard the news from us, their trusted providers, rather than the media, and understood how their needs were going to be met. We also maintained ongoing communication with our vendors and our industry association partners to ensure they were up-to-date on information needed to work proactively and collaboratively during the shortage.


6. Consider the future.

Product shortages are a reality in the health care industry, so considering how solutions or processes introduced during the shortage can be incorporated post-shortage makes sense. Virginia Cancer Specialists has seen, first hand, the benefits of the portable infusion system with certain chemotherapy and pre-meds and plans to continue using it post-shortage.


Preparation and collaboration across your facility and with your vendor partners will yield success in the case of a product shortage, allowing patient care to continue to be your primary focus.


MARIE A. GARCIA, RN, OCN, is Director of Clinical Operations at Virginia Cancer Specialists.

Marie A. Garcia, RN,... - Click to enlarge in new windowMarie A. Garcia, RN, OCN. Marie A. Garcia, RN, OCN