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<p class="MsoNormal" style="line-height:normal"><b><span style="font-size:14.0pt">To All Upstate Nursing Staff<o:p></o:p></span></b></p>
<p class="MsoNormal" style="line-height:normal"><span style="font-size:12.0pt">Hurricane Helene caused significant flooding at Baxter International’s primary IV fluid manufacturing plant in Marion, North Carolina. This facility was Baxter’s largest manufacturing
plant in the world, accounting for more than half of their IV fluid, peritoneal dialysate, and irrigation fluid production.<o:p></o:p></span></p>
<p class="MsoNormal" style="line-height:normal"><span style="font-size:12.0pt">Unfortunately, Baxter is the primary supplier of IV fluids for Upstate and has subsequently limited our ordering quantities to only 40% of our normal usage.<o:p></o:p></span></p>
<p class="MsoNormal" style="line-height:normal"><span style="font-size:12.0pt">(Example: Upstate typically uses 180 cases of normal saline weekly, and we have been reduced to a
<b><i>maximum</i></b> of 54 cases. These 54 cases are not guaranteed and may be further reduced by the supplier.)<o:p></o:p></span></p>
<p class="MsoNormal" style="line-height:normal"><span style="font-size:12.0pt">Therefore, it is critical that we as an organization initiate immediate and robust conservation efforts to maintain sufficient stock for patient care. We are asking all Upstate
providers and nursing to carefully evaluate all patient fluid orders <b>daily</b>.<o:p></o:p></span></p>
<p class="MsoNormal" style="line-height:normal"><span style="font-size:12.0pt">To ensure critical review all EPIC orders for impacted fluids will default to a 24 hour stop date, which means that, if needed, fluids will need to be reordered daily. In addition,
“Keep Vein Open” orders will be limited.<o:p></o:p></span></p>
<p class="MsoNormal" style="mso-margin-top-alt:auto;mso-margin-bottom-alt:auto;line-height:normal">
<span style="font-size:12.0pt">In addition to daily review and 24 hour stop date default please
</span><b><span style="font-size:12.0pt;color:black">take immediate steps to reduce our current rate of IV fluid utilization</span></b><span style="font-size:12.0pt;color:black">.<o:p></o:p></span></p>
<ul type="disc">
<li class="MsoNormal" style="color:black;mso-margin-top-alt:auto;mso-margin-bottom-alt:auto;line-height:normal;mso-list:l0 level1 lfo1">
<span style="font-size:12.0pt">Patients receiving IV medications: Consider whether
<b>the medication ordered can be given via another route (orally, rectally, IV Push)</b> based upon the patient's condition, medication ordered, and current IV push policy. If the answer to this assessment is yes, escalate to the Medical provider for an order
change.<o:p></o:p></span></li><li class="MsoNormal" style="color:black;mso-margin-top-alt:auto;mso-margin-bottom-alt:auto;line-height:normal;mso-list:l0 level1 lfo1">
<span style="font-size:12.0pt">Patients receiving IV fluids: Nursing should assess with
<b>every bag change, and change of shift, whether patients on IV fluids require ongoing IV fluids.</b> Based upon this assessment and determination that it may be possible to discontinue the IV fluids, please escalate immediately to the Medical provider for
an order to discontinue the IV fluids.<o:p></o:p></span></li><li class="MsoNormal" style="color:black;mso-margin-top-alt:auto;mso-margin-bottom-alt:auto;line-height:normal;mso-list:l0 level1 lfo1">
<span style="font-size:12.0pt">Finally, please ensure that our teams do not begin hoarding supplies or attempting to increase your par level of IV fluid. Any changes in demand or request for par level increases will be escalated to the Supply team for further
review and scrutiny.<o:p></o:p></span></li></ul>
<p class="MsoNormal" style="line-height:normal"><span style="font-size:12.0pt">A level 3 incident command has been activated in order to strategize and ensure staff are continually evaluating product availability. We will communicate if any further actions
are needed.<o:p></o:p></span></p>
<p class="MsoNormal" style="line-height:normal"><span style="font-size:12.0pt">Your diligence in conserving these essential resources is critical to sustaining patient care during this shortage. Thank you for your attention and collaboration.<o:p></o:p></span></p>
<p class="MsoNormal"><o:p> </o:p></p>
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