DHA 715 Week 5 Asset and Resource Risk Management Example

Three Days of IV Fluid: Protecting Supplies, Medications, Equipment and Facilities in Four Rural Hospitals

[Student Name]

University of Phoenix

DHA/715: Risk Management in Complex Health Organizations

Week 5 Assignment

[Instructor Name]

[Date]

The rural hospitals, inventories, equipment ages, costs and plans are composites written for a model paper; research findings come from the sources cited.

A telephone call from the region's medical supply distributor arrived on a Tuesday morning: a hurricane had damaged a major manufacturing plant, and intravenous fluid deliveries would be cut by 40% for at least two months. The four rural hospitals had about three days of fluid on hand. The emergency departments used it for dehydration, sepsis and trauma; the operating rooms and inpatient units depended on it. The regional vice president asked what other resources the region could not replace quickly. This paper examines that question and proposes a plan.

Mapping Critical Resources

The region's supply chain, pharmacy, facilities and biomedical engineering teams listed resources in five groups: medical supplies, medications, equipment, facilities and utilities and information systems. For each, they asked what services would stop if it failed and how quickly it could be replaced.

Counting Days on Hand

Of all the measures the teams tried, days on hand told leaders the most. The region held about three days of intravenous fluids, four days of several sterile surgical supplies, five days of certain antibiotics and about a week of protective masks at normal use. Lean inventory had saved money and storage space, but it left little room when deliveries stopped.

Where Supplies Come From

Tracing sources showed concentration. Most intravenous fluid came from a few plants, several generic injectable drugs had only one or two manufacturers and the region bought almost all supplies through one distributor. Concentration lowers prices in normal times and raises risk in bad ones. The teams also found that the distributor's own warehouse, which served the four hospitals, sat three hours away and held limited stock of several items, so the distributor's promise of next-day delivery depended on a single building and a single road that had closed during the last major storm.

Medication Shortages and Patient Outcomes

Shortages are not only an inconvenience. Vail and colleagues studied 27,835 adults with septic shock at 26 hospitals that experienced a norepinephrine shortage in 2011; norepinephrine use fell from 77.0% of patients to a low of 55.7%, phenylephrine use rose and in-hospital mortality was 39.6% for patients admitted during shortage quarters compared with 35.9% in normal quarters, an adjusted odds ratio of 1.15 (Vail et al., 2017). When the first-choice drug runs out, the substitute may carry a cost measured in lives.

What a Broader Review Shows

The pattern holds across drugs. Phuong and colleagues scoped the literature on how shortages affect patients, and most included studies reported negative economic, clinical and humanistic outcomes, including higher out-of-pocket costs, more medication errors, more adverse events, higher mortality and more complaints, although some studies found equivalent or improved outcomes when alternatives were used (Phuong et al., 2019). Those findings support treating shortages as a patient safety risk, linking this week's analysis to the region's safety program.

Lessons From the Pandemic

The pandemic showed how lean supply chains fail under sudden demand. Early in 2020, Ranney and colleagues warned that shortages of ventilators and personal protective equipment put both patients and clinicians at risk, and they called for coordinated national action to increase production and direct supplies to the places with the greatest need (Ranney et al., 2020). Rural hospitals, buying in small volumes, were often last in line. During that period, the region's hospitals reused masks under conservation guidance, borrowed ventilators from the academic center and relied on donations from local businesses. Staff remember those months, and several nurses who left the region cited fear of working without adequate protection.

Equipment Risks

Equipment carries its own risk. The region's only CT scanner at one hospital is eleven years old and has failed three times in the past year, each time sending stroke and trauma patients on a forty-minute transfer. Two hospitals rely on infusion pumps near the end of vendor support, and several anesthesia machines need replacement within three years. The region has no central list of equipment ages or service histories; biomedical engineering tracks work orders by hospital, and no one could say at first how many devices were past their expected life. Building that inventory became the first equipment task.

Facility and Utility Risks

Buildings and utilities are also at risk. The oldest hospital's backup generators passed their last test but are thirty years old, and its roof leaked into the pharmacy during the last storm. Two hospitals sit in areas that flooded during recent hurricanes, and one depends on a single water main.

Balancing Reserves Against Cost

Holding more inventory costs money and space. The region estimated that raising critical items to fourteen days on hand would tie up about $1.2 million in inventory and require new storage. Rather than stockpile everything, it chose to focus on items that are both critical and hard to replace. Each item was placed on a grid of criticality and substitutability: items that are critical and have no substitute receive the highest reserves, items with safe substitutes receive smaller reserves and noncritical items stay on lean ordering. Expiration dates were considered too, since some drugs and fluids would expire before a larger stock could be used.

Plan Element One: Inventory Targets

The region set targets of fourteen days on hand for intravenous fluids, critical injectable drugs, protective equipment and key surgical supplies, and seven days for other high-use items, reviewed each quarter.

Plan Element Two: Supplier Diversification

For each critical item, the region will qualify at least two suppliers or manufacturers where possible and keep a secondary distributor contract for emergencies.

Plan Element Three: A Regional Sharing Agreement

The four hospitals and the network's academic center agreed to share inventory during shortages, with a daily report of critical stock levels and a courier route, so no single rural hospital runs out while others hold supply.

Plan Element Four: Conservation Protocols

Pharmacy and nursing developed protocols for shortages: switching from intravenous to oral fluids and medications when safe, using smaller bags and reserving scarce drugs for patients with the greatest need, with safety checks when substitutes are introduced. Because the norepinephrine study suggests substitutes can carry risk, each protocol names the preferred alternative, its dosing and the monitoring nurses should add.

Plan Element Five: Capital Priorities

Capital requests were ranked by risk to patients: the CT scanner first, generators second, infusion pumps third and the pharmacy roof fourth, with anesthesia machines scheduled over three years.

Measures

The region will track days on hand for critical items weekly, shortages affecting care, equipment downtime, capital projects completed on schedule and medication events involving substitutes. The regional risk committee will review these measures monthly alongside the risk register.

Conclusion

Three days of intravenous fluid revealed how thin the region's margins were. Evidence shows shortages harm patients, from higher septic shock mortality to more errors, and the pandemic showed the limits of lean supply chains. Inventory targets, supplier diversification, regional sharing, conservation protocols and risk-based capital priorities give the rural region a stronger foundation.

References

Phuong, J. M., Penm, J., Chaar, B., Oldfield, L. D., & Moles, R. (2019). The impacts of medication shortages on patient outcomes: A scoping review. PLOS ONE, 14(5), Article e0215837. https://doi.org/10.1371/journal.pone.0215837

Ranney, M. L., Griffeth, V., & Jha, A. K. (2020). Critical supply shortages: The need for ventilators and personal protective equipment during the Covid-19 pandemic. New England Journal of Medicine, 382(18), Article e41. https://doi.org/10.1056/NEJMp2006141

Vail, E., Gershengorn, H. B., Hua, M., Walkey, A. J., Rubenfeld, G., & Wunsch, H. (2017). Association between US norepinephrine shortage and mortality among patients with septic shock. JAMA, 317(14), 1433-1442. https://doi.org/10.1001/jama.2017.2841