This month a very important note about IV fluid shortages, some well-deserved kudos(!), and getting to know GMLOS (geometric mean length of stay).
- Important notes on anticipated IV fluid shortages: We need your help to conserve IV fluids (including irrigation and dialysate). As a result of Hurricane Helene, the Baxter manufacturing facility in North Carolina has been shut down for an unknown amount of time. This facility produces 60% of the country’s IV fluids. A list of the impacted products can be found here. As the FDA and other agencies work on alternative sources and solutions, manufacturing and distribution centers are also limiting allocations to help mitigate over-ordering. State agencies and hospital leadership are meeting regularly to monitor the evolving situation, but we need your help to conserve IV fluids now. For daily updates on our current situation in South Puget Sound and additional recommendations you can go to our SharePoint site here (https://providence4.sharepoint.com/sites/SWSA/SitePages/Baxter-IV-Shortage-updates.aspx).
See the below top 10 conservation strategies to take NOW below:
- Evaluate the clinical need when ordering any IV fluids. Discontinue maintenance/rehydration IV fluids where not absolutely necessary and encourage PO fluids. Give a specific order for volume and frequency of water.
- If IV fluids are needed, please do not order them open ended. Include a duration or volume in your order. Discontinue them as soon as appropriate.
- Convert any medications and especially electrolytes (such as potassium and magnesium) from IV to PO wherever possible.
- Limit the use of TPN as much as possible.
- Antibiotics that can be given as IV push will be changed to this route by Pharmacy.
- Use oral glucose gel and juice as a replacement for dextrose IV.
- Be prepared to replace potassium chloride separately from a maintenance fluid - whether oral or IV.
- Add sodium chloride and potassium chloride oral tablet orders based on lab values.
- Do not open IV fluid overwraps until just before hanging/spiking them.
- All runs >48hrs will be reviewed if severe shortage expected.
2. Kudos on a successful September! Tentatively, for the month of September we reached our lowest ALOS (average length of stay) year to date at both St. Peter and Centralia hospitals at 6.10 and 4.34 days respectively! These aren’t just numbers, this work helped to open beds for our patients who need them … but as always, the work continues every day to ensure efficiency and throughput through our hospitals. One way that we can do that is by getting to know GMLOS (geometric mean length of stay)!
3. Getting to know GMLOS. GMLOS is a statistical measure to assess the tendency of hospital stays based on clinically similar patients or diagnosis-related groups (DRGs). GMLOS also relies heavily on accurate and complete documentation. While GMLOS is only one metric to understand efficiency and discharge planning, it is an important one. Discharge planning that includes awareness of GMLOS and expected length of stay allows us to reasonably prepare the patient and family for discharge, to coordinate resources in anticipation of discharge and to have a goal discharge date in mind. As an example, a patient with a principal diagnosis leading to assignment of MS-DRG 179 Respiratory infection and inflammation without a CC/MCC (complication or comorbidity or major complication or comorbidity) has a GMLOS of 3.2 days, so we would expect most patients with this MS-DRG to go home in 3-4 days. Some will stay shorter; some will stay longer, but we should be able to understand the why behind longer stays (especially extreme outliers) and be able to discuss among the care team. You can find your patient’s estimated length of stay and additional care management notes (including the GMLOS for most patients) in the Summary tab under DC Planning Overview.
