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Patient safety improvement project - Prescription of intravenous fluid for administration in children

 A local guideline and a patient safety improvement project to ensure adherence to guidelines in prescribing IV fluids.

The problem

NPSA issued an alert in 2007 about the risk of hyponatremia in children receiving intravenous fluids.

A prospective audit was performed in November 2012, looking at all 26 children who were admitted to a busy  children’s DGH and prescribed IV fluids over a two week period. Prescription of IV fluid rate, type of fluid used, potassium content as well as monitoring of patient’s renal function, fluid balance and daily weight were audited.

Areas of strong performance were IV fluid rate and IV fluid type.

Areas identified for improvement were fluid balance, daily weights, potassium content in IV fluids and renal function monitoring.

Aims

Area of weakness was identified from the initial audit. Initial audit showed that fluid rate, type and daily monitoring of renal function while on IV fluids were closely adhered to, with compliance rate of more than 90%.

Prescription of potassium containing fluids, monitoring of daily weights and fluid balance were badly done on the initial audit with compliance rate of 40%, 40% and 58% respectively.

We aimed to introduce interventions to improve the outcome and ensure patient safety.

Making the case for change

We took few actions to improve outcome:

A discussion with junior doctors, nurses and allied health care professionals was done during the audit period to identify barriers to achieving compliance in prescription of potassium containing fluids and monitoring of renal function, daily weights and fluid balance.

Results of the project were highlighted to all clinician as well as nursing staff during departmental meeting to raise awareness and identify solutions to barriers identified.

Further education of junior doctors, nurses and allied health care professionals was provided.

An IV fluid workbook was created for all junior doctors as part of the induction process.

A fluid prescription chart was updated to act as a visual cue and to enable accurate calculation of fluid rate and renal function monitoring.

A post-intervention prospective audit was performed.

Your improvement

Learning and next steps

The re-audit showed that our adherence to the trust guidelines in the fluid rate, type and daily monitoring of renal function were maintained.

Prescription of potassium, monitoring of daily weights and fluid balance were poorly done with compliance rate of 40%, 40% and 58% respectively improved to 71%, 71% and 61% during the re-audit after implementing the above interventions.

This project highlights the importance of regular education of staff.

We plan to continue to deliver IV fluid teaching regularly and ensure an IV fluid booklet has been completed by the junior doctors as part of the induction.

Quality assurance/MHRA Registration

Approved by the local Trust.