Due to Hurricane Helene’s impact on major manufacturing facilities, we are experiencing a critical shortage of IV fluids including sodium chloride 0.9%, lactated ringers, PlasmaLyte and D5W. HonorHealth is currently receiving only 40-50% of typical supply volumes, necessitating immediate conservation measures.
 

Current mitigation strategies

Oral hydration protocol

We have implemented a comprehensive oral hydration protocol for Emergency Departments and labor & delivery units, including:

• Structured administration guidelines for Pedialyte
• Specific dosing instructions: Two sips (~30mL) every three to five minutes
• Anti-emetic integration protocol
• Clear progression criteria for fluid tolerance

IV push medication updates

To conserve IV fluids, we have expanded our IV push medication program. The automated dispensing machines now include reconstitution instructions for several antibiotics and other medications that can be administrated via direct IV push rather than infusion.
 
System-level changes

1. 48-hour automatic discontinuation on continuous IV fluids
2. Modified MAR instructions requiring evaluation of oral tolerance
3. Revised saline lock protocols with emphasis on using minimum necessary volves
4. EMR alerts suggesting oral hydration alternatives when appropriate

Clinical guidelines

Patient assessment

Oral hydration protocols have been proven effective for patients with:

• Acute gastroenteritis
• Hyperemesis of pregnancy
• Mild upper respiratory tract infections
• Mild pharyngitis

Monitoring parameters

• Regular assessment of hydration goals
• Specific guidelines for managing treatment-resistant vomiting
• Clear escalation protocols for cases not meeting hydration targets

Implementation timeline

These conservation measures took effect on Oct. 9, 2024, and will remain in place until supply chains stabilize. Unlike some regional facilities, we have maintained our elective surgery schedule through careful resource management.
 
Feedback and support

Your collaboration in these conservation efforts is crucial. Please direct any questions or suggestions for protocol refinement to the informatics team or department leadership.
 
Reference documents

• Oral hydration protocol memo
• Nursing conservation measures

For detailed medication reconstitution guidelines or specific oral hydration protocols, please consult full protocols and guidelines above.