The health system, which serves Washington, D.C., Maryland and Virginia, has adopted new practices around fluid management, a shift that it plans to continue as part of a broader “fluid stewardship” program.
Bonnie Levin, vice president of pharmacy services at MedStar, said fluid stewardship is now considered a permanent clinical practice alongside resource-management practices like antibiotic and opioid stewardship.
The decision to reduce IV fluid use acknowledges a growing consensus among clinical leaders that perioperative fluids had become routinely overused. MedStar’s response to the shortage has focused on reimagining fluid use within enhanced recovery after-surgery care pathways, which emphasize evidence-based practices to speed up recovery after surgery.
Following the IV shortage, MedStar made rapid changes to its system, including revising over 300 order sets and more than 2,500 IV-related order sentences. In many cases, the revised orders favored oral hydration over routine IV fluid use.
