ABSTRACT
Background: Institutions across the country are experiencing delays in receipt of essential infant formula and feeding supplies due to a supply chain crisis. The supply chain crisis commenced during the COVID-19 pandemic and has continued into present day, late 2022. The supply chain crisis led to an unstable supply of ready to feed (RTF) infant formulas for a children's hospital within a medical center containing a neonatal ICU, pediatric ICU, pediatric floor and newborn nursery. RTF formulas are the recommended inpatient infant feeding due to their sterility. Method(s): To address these RTF formula supply challenges, interprofessional leadership from Clinical Nutrition, Nursing and Supply Chain developed a local infant formula committee. The committee convened based on the needs of the institution, ranging from daily to weekly beginning October 2021 to present day. A shared, live spreadsheet allowed for real time inventory of RTF formula on the Nursing units and amount of product pending receipt in supply chain. Upon identification of low RTF supply, increased usage or RTF outage, the committee implemented a three-tiered action plan for each unit. For the first tier, the formula roomdiluted a higher calorie RTF liquid with water to the desired calorie density (example RTF 24 to RTF 20 calorie/oz). The medical team had an infant formula substitution list to guide feeding alternatives for specialty preparations. In the second tier, the formula room prepared stock formula for each unit daily, with a 24-hour expiration time, to accommodate potential for rapid census changes outside of the formula room operation. As a third layer of safety, powder emergency stock was pre-measured and sent with instructions for Nursing to reconstitute with sterile water, in a dedicated space, if all stock RTF formula was used. The powder emergency stock expired in 30 days, which allowed for a longer shelf life than the stock RTF formula. Result(s): It is practical for institutions without a formula room to implement similar processes using dedicated infant formula preparation space and storage. It also worth mentioning during this time there was a national shortage of powdered infant formulas due to a recall issued in May of 2022 by a major formula manufacturer. The national shortage included elemental powdered formulas for which there is no RTF alternative. Management of elemental formula outages were managed on a case-by-case basis by the Clinical Nutrition department. The Committee also convened to discuss allocations and identify substitutions for other neonatal and pediatric specialty items including sterile water, feeding preparation bottles, ENFit syringes and syringe caps, breastmilk collection containers and infant feeding nipples. Conclusion(s): Using this three-tiered process, the medical center provided sterile RTF formula to infants when available, remained consistent with best practices, predicted inventory needs consistent with usage and prevented waste of powdered infant formula in a time of scarcity. Technology and the anticipatory interprofessional leadership using a three-tiered action plan equipped the medical center for this most extraordinary infant formula crisis nationally.
ABSTRACT
This Special Issue focuses on how EU politics, policies and institutions, all nested in the past, have a bearing on welfare states in the context of the ongoing COVID-19 pandemic. In this introductory article, we first provide a brief overview of the growing scholarship on the impact of the pandemic on both national welfare systems and EU policies. We then contextualise the initial pandemic policy responses by high-lighting the economic challenges to European welfare states leftover from the Great Recession and Eurozone crisis before outlining the timeline of the EU reaction to the COVID-19 crisis, culminating in the Next Generation EU deal. Finally, we summarize the distinctive empirical and theoretical perspectives of each contribution to this Special Issue. Taken together, the articles in this issue offer a much-needed analysis of the interplay between EU level and member state politics that furthers our understanding of the social and economic policies implemented in the first year of the COVID-19 pandemic in Europe.
ABSTRACT
This article presents an analysis of why it was possible to reach an agreement on the Next Generation EU (NGEU), the EU's fiscal and policy response to the COVID-19 pandemic, since the deal breaks with the norms of no common debt issuance and will result in significant redistribution across Member States through grants. Based on an in-depth case study analysis, we identify three main dimensions of conflict underlying the political negotiations: the fiscal dimension, the rule-of-law dimension and the policy dimension, especially the climate and digitalization agendas. Various coalitions of actors were able to negotiate on these aspects, keeping a balance between their main priorities, but also making concessions, to enable an agreement. Our analysis reveals that the Franco-German alliance has been revived, enabling the grant instrument in the NGEU to be adopted;a new alliance of small rich northern states named the Frugals' has emerged as a surprisingly strong coalition, insisting on conditionality for accessing the grant;a clear Polish-Hungarian front has appeared to be challenging the EU's commitment to the rule-of-law;and a weakly coordinated Spanish-Italian front was successful in terms of securing grants as an instrument. The article also assesses that despite the agreement on the deal, there will continue to be battles in the NGEU, especially on the fiscal and rule-of-law dimensions. Yet, it could represent a ‘Hamiltonian moment,’ if the NGEU becomes a permanent fiscal instrument, which would advance European integration further. © 2021 The Authors. Social Policy & Administration published by John Wiley & Sons Ltd.