P3.060: IV Fluid Disruption: Pioneering Operational Triad Teams for Emergency Response

Introduction: In the complex landscape of healthcare delivery, the capacity to swiftly and effectively address supply chain disruptions is crucial, especially concerning essential resources such as intravenous fluids (IVFs). Recent challenges surrounding the availability of IVFs highlighted the need for innovative strategies that balance resource allocation and ongoing patient care and safety.

Case Description: In September 2024, Hurricane Helene unleashed an unprecedented storm surge in North Carolina, leading to flooding at a major IV fluid manufacturing facility which halted all production and distribution, resulting in a nationwide shortage. At Lucile Packard Children’s Hospital Stanford (LPCHS), Supply Chain operates as a shared service with two other adult hospitals. In response to the crisis, weekly meetings were initiated by the Chief Pharmacy Officer and the Associate Chief Medical Officer for Patient Access and Flow to raise awareness and gather conservation strategies for IVFs. Subsequently, a Joint Hospital Command Center was activated, employing the Hospital Incident Command System (HICS) across all three hospitals to ensure the equitable, ethical, and transparent conservation efforts.
Our Joint Hospital Incident Management Team (HIMT) comprised a diverse group of experts in crisis standards of care, ethics, risk management, infection prevention, supply chain management, and chief medical officer/associate chief medical officers who acted as Medical Technical Specialists. Supply chain leaders identified at-risk Stock Keeping Units (SKUs)—specific items categorized by type and volume—and pinpointed departments with high utilization of these SKUs. To facilitate targeted conservation efforts, we established unit-based triad teams consisting of a pharmacist, nurse, and clinician. These teams were instrumental in making focused requests for conservation strategies regarding at-risk SKUs and executing approved measures. The Pediatric Operations Section approved a total of 74 conservation strategies, of which 40 were implemented. All strategies underwent review by the Pediatric Operations Section before being presented to the Joint Hospital Incident Management Team for final approval and implementation across all three Stanford Medicine hospitals.

Discussion: To tackle the impacts of a national IVF shortage, we formed unit-based triad teams. This approach proved to be an effective communication and engagement method. These interdisciplinary teams enabled targeted requests for conservation efforts at the unit/department levels, particularly for high utilizers of specific at-risk IVF products. The communication of approved strategies from the Joint Hospital Command Center through these triad teams ensured equitable implementation of conservation measures across all units and departments. This collaborative structure not only enhanced our response to the IVF shortage but could also be adapted for future disruptions in IVFs or medications.

Conclusion: The establishment of interdisciplinary unit-based triad teams was an efficient and effective response mechanism during the IVF shortage. These teams facilitated vital communication and engagement at the frontline level, establishing a best practice for future healthcare challenges.