By Amye Anderson
UCBJ Managing Editor
UPPER CUMBERLAND – Devastation continues to be felt nearly three months after Hurricane Maria, the tenth-most intense Atlantic hurricane on record, slammed Puerto Rico. While residents there continue to clean up and rebuild infrastructure damaged during the hurricane, the impact from the powerful storm is being felt stateside – more specifically, at hospitals across the US.
Puerto Rico is home to manufacturing facilities for nearly 90 vendors of various medical supplies and devices – items ranging from IV bags, surgical mesh, cardiac pacemaker leads, and blood collection needles, to name a few. Plants for brands like Merck, Pfizer, Astra Zeneca, and C.R. Bard, Inc. have been experiencing lower production volumes or have been offline entirely since the hurricane plowed through the island nation in September.
“When that hurricane came through, it came through pretty much the gut of Puerto Rico,” Kevin Strong, director of materials management at Cookeville Regional Medical Center, told the hospital’s board last month. “There were about 88 vendors in that area overall. Out of those 88 vendors, we saw about 58 of those vendors that affect Cookeville Regional here that we do business with day in and day out.”
“Something as simple as drawing a patient’s blood for the proper lab work – we’ve seen some issues with some of that stuff,” he added. “We had to actually postpone a conversion because we couldn’t get product until a couple of weeks later.”
Along with collection supplies, Strong noted the hospital is also having issues acquiring surgical meshes from its regular supplier.
“Immediately after the hurricane hit, about five days after that, we received a letter from CR Bard that all products were immediately on backorder and they did not know when they were going to ship,” he said.
Strong did note that the hospital’s inventory of cardiac pacemaker leads has kept them from experiencing a “huge issue” with any shortages there.
Similar issues are reportedly being experienced at hospitals across the UC as facilities work to find alternative ways of administering medication and ensuring patients continue to receive adequate care all while vendors continue working to bring their affected manufacturing facilities back to pre-hurricane production levels.
One common shortage – IV bags and solutions.
In Crossville, Cumberland Medical Center, like many hospitals across the country, has been affected by shortages of IV solution and IV nutrition bags manufactured in Puerto Rico.
“Our health system has ongoing contingency plans in anticipation of supply shortages or other business interruptions that might affect the delivery of patient care,” said Dr. Mark Browne, Senior Vice President and Chief Medical Officer of Covenant Health.
CMC, part of the Covenant Health family, participates in the group’s multi-hospital pharmacy taskforce, something Browne says has been preparing for this type of shortage since the hurricane occurred.
“Over the past couple of months, Covenant Health hospitals have managed existing IV resources, shared supplies throughout our health system, and found alternative manufacturers to help cover any delivery gaps,” Brown said.
For example, nurses there have begun administering antibiotics directly into an IV line rather than using a bagged IV solution.
“As a result, our patients have continued to receive all medications without interruption and Covenant Health has not experienced any cost increase,” Brown added.
Pharmacists at CRMC are looking at implementing several mitigation strategies of their own, including a completely redesigned drug delivery system to be put in place that would allow all medications that utilize mini-bags or small IV bags that can be pushed intravenously – given by push over five minutes or less – to be placed in syringes for nurses to administer over safe time intervals. It’s a measure that would reportedly increase the workload significantly – as much as 300 percent in the IV prep area.
“We have spent about almost $19,000 in alternate supplies on the materials management side,” said Melahn Finley, CRMC’s Director of Marketing, noting that dollar amount does not include the labor cost needed to manage the situation. She added that, while no numbers are available yet, the hospital’s in-house pharmacy is “probably being affected much more due to the staff time” involved.
There are vendors who can help fill in the gaps for hospitals experiencing supply shortages but at a much higher cost.
“There are some companies out there, what Casey (White, MD, CRMC pharmacy director) and I refer to as ‘Gray Market Vendors’ that seem to be able to get product but they sell it at a huge cost markup,” Strong told CRMC board members. “What the hospital can buy it for and what they sell if for is often 2,000 to 3,000 percent higher and we’re just not willing to pay that. So, we’ve decided that, at all costs, we’d try to avoid that if we can.”
Strong’s presentation to the CRMC board also indicated parenteral nutrition, or nutrition given intravenously, is also being impacted; with all components used for feeding patients intravenously reportedly on backorder and in short supply.
“We haven’t felt it here yet but we will. It will be about a month and we’ll start feeling it,” White said.
Strong says CRMC is looking into acquiring alternatives for the mini bags from other suppliers, noting they are looking into companies in Australia, the UK, Spain, and Ireland.
Saint Thomas Health, whose nine-hospital network includes several hospitals located throughout the UC – including the cities of McMinnville, Sparta, Smithville, and Woodbury – provided the following statement to the UCBJ regarding the impact of Hurricane Maria: “We are working diligently with suppliers to ensure we deliver the highest quality of care for those we serve. Our team will continue to monitor this situation closely.”
While recovery efforts continue in Puerto Rico, some of the supply companies there are already back online. Medtronics, one of the affected suppliers Strong cited in his report, says all production lines at every one of its facilities there is operating at pre-hurricane levels.