- The average number of days between the latest U&E’s and a fluid prescription decreased from 2.2 days to 1.0 day.
- The incidence of AKI decreased 14% to 10%.
- The incidence of deranged U&E’s decreased from 48% to 35%.
- All patients had a documented review of both fluid status and balance.
- IV fluid bundle for ward based use – click to download a copy
- Production of a new IV fluid bundle (Click below to download), led to significant improvements in the measured outcomes and balancing measures.
- Only 25% contained the correct amount of glucose.
- Patients received excessive amounts of sodium within their IV fluid prescriptions, yet minimal potassium.
- 16% had the correct volumes prescribed for maintenance fluids.
- The knowledge base amongst medical staff regarding IV fluids was extremely variable, sometimes poor. At times, some prescriptions were placing patients at increased risk of associated complications. There were considerable variations in IV fluid prescriptions none of which adhered to NICE guidelines.
Previous retrospective reviews of prescriptions within our Trust have identified poor control of the process. IV Fluids are drugs Infographic (Wilkinson J N, Lyness D 2018) The problem Non-parent team prescriptions, particularly out-of-hours, require extra care and in particular should not be done as a duplication of the last prescription in order to save time.Ĭlearly, there are emergent situations whereby fluids need to be prescribed outside of this policy. Ideally, fluids should be prescribed on the ward-round by the team who knows the patient and their history. It is therefore imperative to carefully assess the individual, their requirements and the clinical picture in order to tailor IV fluid plans safely. Consequently, this puts patients at increased risk of serious harm and may incur unnecessary costs to hospitals. This is thought to be due to lack of knowledge and experience, which often breeds confusion. Evidence suggests that such prescriptions are rarely ever done correctly despite the presence of clear guidelines. Often, the task is delegated to the junior most members of the team. They have their indications, benefits, risks, side-effects and complications. Intravenous (IV) fluids are some of the most commonly prescribed day-to-day drugs. It incorporates much of this publication: Introduction It aims to aid in the management of electrolyte replacement and minimise the potential harm to patients from fluid mis-management. This post aims to guide clinicians through the assessment and management of patients requiring IV fluids. NGH IV Fluid policy (Currently in review) Background Summary
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