Concern for rural practices as IV fluid shortage bites

A global shortage of multiple intravenous (IV) fluid products is threatening healthcare offerings across Australia, and there are fears it will be rural patients bearing the brunt.
 
The Therapeutic Goods Administration (TGA) has revealed there are currently shortages from all three Australian suppliers: Baxter Healthcare, B.Braun, and Fresenius Kabi.
 
In the wake of the shortage, some hospitals have even had to put up signage on their wards warning staff to take care with their saline use.
 
The shortage is particularly affecting multiple bag sizes of sodium chloride 0.9% (saline) and compound sodium lactate (Hartmann’s solution) products.
 
The TGA said it is ‘closely monitoring the IV fluid situation‘ but confirmed that supply will continue to be constrained throughout this year.
 
‘The shortages are due to multiple factors including global supply limitations, unexpected increases in demand, and manufacturing issues,’ it said.
 
‘Managing the shortage and supply of IV fluids is a priority for us, as we understand these medicines are of critical importance. 
 
‘We work with pharmaceutical companies to communicate information about shortages of their medicines to health professionals and patients.’
 
RACGP Acting Vice President Dr Ramya Raman told newsGP she was particularly concerned about patients living in rural and regional areas and the impact the shortages could have.
 
‘When such shortages occur, it just means that we’re needing to really prioritise,’ she said.
 
‘In rural and remote areas, there would be more procedures that they are doing, and the general practice may be the only port of medical access for patients in that area.
 
‘In general practice, the answer is yes, we do use it, but the circumstances do vary depending on the situation and the location of the practice.’
 
In a bid to alleviate the impacts of the shortage, the TGA has approved several overseas-registered alternative saline fluids, and says it is continuing to ‘prioritise evaluation of additional applications’.
 
‘We continue to collaborate with jurisdiction health departments, and suppliers of Australian-registered IV fluid products to monitor the situation and address any regulatory barriers to supply,’ it said.
 
‘However, we cannot compel companies to register, manufacture, or increase supply in Australia.’
 
But as Dr Raman said, medical clinics must stock the fluids as ‘emergencies don’t come planned’.
 
‘Having to manage the brunt and the cost of that is quite huge because we’re having to make sure that we do have adequate stock for the unplanned emergency that might come in through the door,’ she said.
 
The shortage has led to fears of cancelled surgeries and delayed procedures, as well as medical centres having to share available stock.
 
It comes as a number of significant medicine shortages remain in Australia, with the TGA currently listing 408 medicines as in shortage and 44 in ‘critical shortage’.
 
A TGA investigation into ‘Medicine shortages in Australia – Challenges and opportunities’ was launched earlier this year in a bid to better understand the growing issue.
 
Of the 221 submissions into the inquiry, many raised the ‘considerable time and resources’ it takes to monitor and address medicine shortages, their impacts on health and finances, and the disproportionate impact on vulnerable populations.
 
Most respondents called for improved access to medicine shortages information, including receiving notifications sooner, notifications being tailored to need and interest, and greater transparency about the reasons for a shortage.
 
‘When a health professional prescribes a medicine, they often won’t know if it is available or in short supply, or where to find information about alternatives, especially if a medicine has been discontinued,’ the TGA said was one challenge raised.
 
‘Consumers experience significant impacts when there are few or no suitable alternatives available for a medicine in shortage or discontinued,’ was another.
 
The TGA says it is now considering the feedback and will soon share it with relevant stakeholders to develop recommendations on future medicine shortages reform priorities.
 
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IV fluids medication shortage rural general practice saline TGA Therapeutic Goods Administration