A pharmacy-led dual-source informatics framework for intravenous fluid stewardship during a national shortage

PURPOSE: National shortages of intravenous (IV) fluids pose persistent operational challenges for health-system pharmacies, prompting the development of a pharmacy-led informatics approach to improve timely stewardship and forecasting. We describe the design and implementation of a dual-source framework that integrates electronic health record (EHR)-derived IV fluid utilization data with pharmacy inventory management systems to provide timely operational visibility. The objective of this innovation was to support anticipatory decision-making and coordinated stewardship during a national IV fluid shortage. SUMMARY: During the 2024 national IV fluid shortage, our institution developed a dual-source dashboard in the perioperative setting, where IV fluid use is high and documentation is structured and timestamped, that combined timely clinical utilization signals with pharmacy inventory data to generate actionable operational metrics. Patient-level IV fluid administration data were extracted from the EHR using structured query tools and processed through automated data integration pipelines. These data were normalized to pharmacy stock-keeping units and integrated with on-hand inventory data to calculate a rolling daily burn rate and projected days of supply. Metrics were refreshed hourly and visualized in a centralized dashboard accessible to pharmacy leadership and clinical stakeholders. Predefined escalation thresholds supported proactive review, allocation planning, and coordination with institutional drug shortage mitigation strategies. Although developed during the 2024 shortage, the framework was continuously monitored and validated through April 2025 to confirm stability beyond the acute shortage period. CONCLUSION: Integrating EHR-derived utilization data with pharmacy inventory systems enabled anticipatory IV fluid stewardship during a national shortage. This platform-agnostic, dual-source framework provides health-system pharmacists with a scalable approach to improving situational awareness, forecasting risk, and coordinating multidisciplinary responses to future drug and supply-chain disruptions.