What You Can Do: Sterile Water for Injection Shortages in Hospitals

Backorders and shortages of sterile water for injections continue to plague every hospital’s staff, and likely will for the foreseeable future. In fact, the shortages have become so severe this winter that the American Society of Health System Pharmacists (ASHP), in conjunction with the University of Utah, published a series of best practices for how to handle this lack of availability.

Having little to no sterile water hits hospital patients particularly hard since sterile water for injection remains an essential ingredient in preparing many drug products for intravenous use. Several hospitals across the country have reported being unable to obtain any supplies of 10 ml and 20 ml vials since December 2017.

8 Ways to Manage Your Sterile Water Supply

Julie Rubin, PharmD, BCPS, CompleteRx’s director of clinical services, has several recommendations for how hospital pharmacy staffs may handle the sterile water for injection shortage:

• When possible, instead of using 10 ml or 20 ml vials, draw from larger bags containing 500 ml, 1L or 2 L. CompleteRx pharmacies are estimating what is likely to be needed for 24 hours, then batching their sterile water under a hood. Waste can be a significant downside of this approach so it’s important to be conservative in your estimates.
• Encourage medications to be given orally when possible. Admittedly, oral administration is not always possible with critically ill hospitalized patients, but this approach can help the pharmacy conserve available supplies for those patients and medications that absolutely must be administered through injection.
• It varies widely, but some medications have been tested for mixing with normal saline. Check to see if frequently prescribed medications in your hospital have been tested by their manufacturer for use with alternative mediums.
• Count all sterile water supplies daily to maintain tight control and sustain general awareness among staff about the shortage.

“We all need to double and triple check our work given that all these shortages are creating so many new workflows,” said Rubin. “I really worry about the potential for medication errors. We need to report these situations so that management fully understands how these shortages impact the delivery of care.”

ASHP provides these additional suggestions, many tried by member hospitals, for handling the sterile water for injections shortage:

• Review hospital contracts and existing customer relationships and explore potential new sources of supplies, if any are available. Call daily to inquire about availability.
• Consider ways to conserve sterile water for injection such as finding products that do not require reconstitution with sterile water for injection, including commercially available premixes, dual-chamber flexible containers.
• Evaluate a return to IV infusion via minibag for drugs whose mode of delivery, because of the shortage of small-volume parenteral solutions, had become IV push via syringe.
• When possible, have nurses use vial adapters to mix antimicrobials and other medications when the dose is the same as a full vial.
• Remove all sterile water vials from automated dispensing cabinets.

Here at CompleteRx, we encourage hospital pharmacy staff to become advocates for your patients’ needs. Let your elected representatives in Washington, D.C. know that you need their support. The ASHP offers an easy-to-use online form to help you send messages to your Congressional delegation.