Emergency Preparedness to Help Minimize Product Shortages and Substitutions
By: Suzanne Smith, MS, RD, LDN, IBCLC and Caroline Steele, MS, RD, IBCLC, FAND
The increasing frequency of natural and environmental disasters, along with public health emergencies such as the COVID-19 pandemic, highlights the critical importance of having hospital staff prepared with the knowledge, skills, and abilities to respond. The ability to care for and protect vulnerable infants depends substantially on the preparedness of the staff. Health care institutions are strongly encouraged to know and prepare for disaster scenarios and consider unanticipated events that could create an interruption of usual service.1
Ensuring safe, high-quality delivery of infant feedings is a critical component in the event of a disaster. Examples of disasters include natural disasters (floods, earthquakes, ice/snowstorms), human-made disasters (chemical spills, explosions), disease pandemics, staffing crises, technology interruptions (cyber-attacks, power outage), bioterrorism, terrorist attacks, or product shortages. Understanding each type of disaster and its implications on infant feeding is key to a well-developed plan.2
Adequate planning starts with assessing vulnerabilities and outlining plans for the provision of human milk and formula feedings safely in the event of a disaster.1, 3-4 Tools such as the failure mode effect analysis (FMEA), hazard analysis critical control point (HACCP), and plan, do, study, act (PDSA) processes are useful in identifying potential risks or failure points in an emergency.1-4 In addition, the Federal Emergency Management Agency (FEMA) has defined five areas – prevention, protection, mitigation, response and recovery – that can serve as a framework for guiding and assisting an organization with integrating infants into all stages of emergency management.5 Readily available nutrition-specific plans should be part of the overall facility emergency preparedness program detailing handling human milk and formula during a disaster. It is important to have both paper and electronic copies, as computer systems may be nonoperational during a disaster.
Emergency plans should include a description of communication methods that are both internal and external to the facility. With the dependence on technology, downtime procedures and manual processes for order transmission, calculation of feeding recipes, and feeding labeling, as well as placing orders for supplies with vendors, are necessary. It may be beneficial to have pre-established plans with vendors for the automatic provision of required goods or services if communication becomes disrupted. An example of a pre-established plan is an agreement with a distributor that a set amount of formula be automatically delivered in the event of a disaster, even if the facility is unable to place an order through usual processes.
Inventory management includes understanding the daily needs of the facility’s patient population. It is recommended that formula products and water should be available for sheltering in place for up to 72 to 96 hours.4 According to the Academy of Nutrition and Dietetics (AND), the facility emergency plan should include identification of alternative water supplies, the amount of water required to operate, and a determination method of the water quality after the disaster.6
At a minimum, an emergency plan should include the following:1,3,4,7,8
- Establishment of an emergency power supply for refrigerators and freezers
- Encouragement of breastfeeding mothers to put their infants to breast whenever possible
- Plan for procurement of adequate supplies such as sterile water, formula, bottles, and nipples
- Trained personnel for manual calculations of enteral feeding recipes and preparation
- Establishment of downtime procedure manuals for order transmission
- Establishment of an approved substitution list for infant/pediatric formulas within the same category of formulas
- System for monitoring infection and quality control
- Disaster planning includes staff education using the written plan for an effective response to emergencies.1,7-8 Regularly scheduled staff education will help maintain readiness and is considered best practice.1
Essentially all products required for the safe preparation and delivery of infant nutrition are vulnerable and/or have been directly impacted by recent shortages. Infant formula shortages impact healthcare facilities supply by forcing clinicians to base feeding decisions on what products are available rather than the most clinically appropriate product. It is important to have awareness regarding infant formula manufacturers as any unanticipated disruption in the supply chain can be problematic. With very little redundancy in the marketplace, when one manufacturer closes or stops production, there are major ramifications, especially with products that are considered very specialized such as products designed for patients with metabolic disorders.
Emergency preparedness regarding product shortages reduces the risk for disruption in patient care. Action planning should include:9
- Establishing a multidisciplinary team of key stakeholders (providers, registered dietitians, human milk/formula room personnel, nursing, leadership, supply chain, etc.)
- Standardizing reporting policy for communicating product shortages
- Contacting formula company area representatives
- Standardizing process for managing shortages including identifying appropriate alternatives when a product is unavailable
- Managing and tracking hospital supply
- Encouraging the use of human milk or donor milk and relactation
- Working with information systems to create substitute enteral nutrition order sets
- Implementing guidelines for appropriate use or rationing strategies of restricted product
- Creating weaning algorithms for specialty and/or metabolic formulas if appropriate
- Maintaining communication among departments
- Educating staff
Guidance for the management of enteral nutrition product and sterile water shortages are sparce. Insights gained from prior shortages should be used in the development of specific strategies to manage future enteral nutrition product shortages. Organizations can reduce the effects of the shortages by developing procedures for monitoring inventory and implementing conservation strategies before available supply escalates to crisis levels. The American Society for Parenteral and Enteral Nutrition (ASPEN) and North American Society for Pediatric Gastroenterology, Hepatology & Nutrition (NASPGHAN) have created resources aimed at providing clinical suggestions during potential supply challenges.10-12 Engage your hospital registered dietitians/clinical nutrition department for assistance and guidance.
Emergency plans can be developed, assuring the safe and accurate provision of human milk and formula feedings in the event of a disaster or downtime situation. Ongoing monitoring is critical for patient safety, fiscal responsibility, and efficiency.
At Timeless Medical Systems, we offer a variety of solutions to improve the safety of your most vulnerable patients. Our Timeless Medical Women & Infant System™ barcoding software can help safeguard your patients through bar code scanning technology of human milk, donor human milk, infant formula, additives, etc. and serves as an integral tool for inventory monitoring. Our Timeless Medical Nutrition Source™ helps clinicians find appropriate enteral product substitutions in times of recalls and shortages.
For more information about the Women and Infants System™ please visit our website at www.timelessmedical.com or email us at sales@timelessmedical.com.
References
- Barfield, W. Krug, S. Committee on fetus and newborn, disaster preparedness advisory council American Academy of Pediatrics. Disaster Preparedness in Neonatal Intensive Care Unit. Pediatrics. 2017;139(5):e20170507
- US Department of Health and Human Services. Pediatric terrorism and disaster preparedness. https://archive.ahrq.gov/research/pedprep. Accessed August 10, 2024.
- American Academy of Pediatrics. Infant Feeding in Disasters and Emergencies. 2020. Accessed August 10, 2024. https://publications.aap.org/DocumentLibrary/Solutions/PCO/FormsTools/disasterfactsheet.pdf
- American Academy of Pediatrics. Pediatric Disaster Preparedness and Response Topical Collection. 2022. Accessed August 10.2024. https://downloads.aap.org/AAP/PDF/Topical-Collection%202022.pdf
- United States Department of Homeland Security. Federal Emergency Management Agency. 2020. Mission Areas and Core Capabilities. Retrieved August 10, 2024. https://www.fema.gov/emergency-managers/national-preparedness/mission-core-capabilities.
- Cody M, Stretch T. Position of the Academy of Nutrition and Dietetics: food and water safety. J Acad Nutr Diet. 2014;114(11):1819-1829.
- Commission on Dietetic Registration. 2023. Emergency Preparedness Playbook. https://www.cdrnet.org/vault/2459/web/SoE%20Emergency%20Preparedness%20Playbook_2023%20w.updated%20cover.pdf. Accessed August 10, 2024.
- Sadler, Jessy. Emergency preparedness in foodservice operations – taking first steps to ensure continuity of essential services during disasters. Nutrition and Foodservice. 2023. 20-24
- Mulherin, D. Kump, V. Shingleton, K. Managing nutrition support product shortages: What have we learned? Nutr in Clin Pract. 2023;38(1):27-45.
- Enteral nutrition infant formulas. Accessed August 13, 2024. https://www.nutritioncare.org/Guidelines_and_Clinical_Resources/EN_Formula_Guide/EN_Infant_Formulas/
- Managing EN supplies during increased demand. American Society for Parenteral and Enteral Nutrition. Accessed August 113, 2024. www.nutritioncare.org/ManagingENSupplies/
- North American Society for Pediatric Gastroenterology, Hepatology and Nutrition. NASPGHAN tools for infants and children affected by formula shortages. Accessed August 13, 2024. https://naspghan.org/recent-news/naspghan-tools-for-hcps-affected-by-formula-recall/
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Ensuring the right patient receives the right feed, right now is more than a slogan for them. It drives their work to ensure clinicians have the confidence they need within the timeframe they have to provide the BEST care to the most fragile of patients in the hospital.
The material presented in this blog represents the opinion of the author(s) and not necessarily the views of Synova Associates. Synova Associates does not endorse any specific products or organizations but strives to connect its industry partners with leaders interested in product/educational innovation.
