scholarly journals P13 Optimising paediatric intravenous fluid management plans: a quality improvement project

2020 ◽  
Vol 105 (9) ◽  
pp. e12.2-e13
Author(s):  
Jenny Gray ◽  
Susie Gage
Keyword(s):  
Patient Safety ◽  
Nursing Staff ◽  
Fluid Balance ◽  
Medical Staff ◽  
Fluid Management ◽  
Management Plan ◽  
Intravenous Fluid ◽  
Safety Alert ◽  
Management Plans ◽  
National Patient

IntroductionIntravenous (IV) maintenance fluids are often prescribed post-surgery when enteral routes are contraindicated. Serious consequences have been documented when poor fluid management has occurred, as highlighted in the National Patient Safety Alert (NPSA) 22; reducing the risk of hyponatraemia; when administering IV fluids to children.1 In response to this, the National Institute for Health and Care Excellence (NICE) published their guidance in December 2015 regarding IV fluids in children.2 Based on NICE recommendations, a pan hospital fluid guidance was produced. Within the NICE and hospital’s own guideline it states that there should be a daily fluid management plan documented. It has been well recognised that this daily fluid management plan was not routinely been completed; hence showing non-adherence to our hospital policy and NICE recommendations.AimsPrimary aim was to improve the documentation of the daily fluid management plan; aimed at the medical staff and the secondary aim was to improve the monitoring requirements of IV fluids and documentation of these; largely aimed at the nursing staff.MethodsA simple sticker was designed and attached to continuous sheets for medical notes which had a checklist of monitoring requirements and a section for fluid balance. Additionally, 2 posters were produced; one aimed at medical staff for documenting a fluid management plan and one aimed at the nursing staff with the monitoring requirements. These posters were displayed on the paediatric surgical ward.ResultsA total of 22 patients who were prescribed IV fluids were identified for a baseline measurement, an equal number of patients were compared after the intervention. Neonates and children receiving total parenteral nutrition were excluded from the data collection. There were 41% of daily fluid management plans completed pre intervention and post intervention there were 56% completed; showing a 15% increase in completion. As regards the monitoring indications; there were increases for nursing fluid balance completed from 19% to 46%, blood glucose taken and recorded from 64% to 83% and the daily weight documented from 10% to 49%.ConclusionsThis short QI project shows that implementation of an intervention did improve outcomes across all indications investigated. The results are not as dramatic as first hoped, but this is largely due to the short time scale of 4 weeks to introduce our change and it coincided with the change-over month of junior medical staff. With further education and champions within the medical and nursing teams; further improvement is very much possible, with the main aim in reducing risk and improving patient safety.ReferencesNational Patient Safety Alert: Reducing the risk of hyponatraemia when administering intravenous infusions to neonates 2007. Available at https://www.sps.nhs.uk/articles/npsa-alert-reducing-the-risk-of-hyponatraemia-when-administering-intraveneous-infusions-to-neonates/ [Accessed 12th June 2019]NICE guidance: Intravenous fluid therapy in children and young people in hospital. Available at https://www.nice.org.uk/guidance/ng29 [Accessed 12th June 2019]

The impact of the National Patient Safety Agency intravenous fluid alert on iatrogenic hyponatraemia in children

2010 ◽  
Vol 95 (Suppl 1) ◽  
pp. A46.1-A46
Author(s):  
S Drysdale ◽  
T Coulson ◽  
N Cronin ◽  
Z-R Manjaly ◽  
C Piyasena ◽  
...  
Keyword(s):  
Patient Safety ◽  
Intravenous Fluid ◽  
National Patient Safety Agency ◽  
National Patient ◽  
The Impact

Assessment of the implementation of a national patient safety alert to reduce wrong site surgery

2008 ◽  
Vol 17 (6) ◽  
pp. 409-415 ◽  
Author(s):  
P Rhodes ◽  
S J Giles ◽  
G A Cook ◽  
A Grange ◽  
R Hayton ◽  
...  
Keyword(s):  
Patient Safety ◽  
Wrong Site Surgery ◽  
Safety Alert ◽  
National Patient ◽  
Wrong Site

Fluid management: An update for perioperative practitioners

2021 ◽  
pp. 175045892096417
Author(s):  
Christopher Wood
Keyword(s):  
Fluid Balance ◽  
Fluid Management ◽  
Postoperative Nausea And Vomiting ◽  
Perioperative Period ◽  
Adverse Outcomes ◽  
Intravenous Fluid ◽  
Team Approach ◽  
Control Mechanisms ◽  
Physiological Control ◽  
Comprehensive Overview

An interprofessional team approach is required to achieve optimum fluid balance for patients during the perioperative period. Incorrect management of fluid assessment and monitoring is associated with adverse outcomes. The scientific understanding of perioperative fluid balance has improved over recent years leading to changes in clinical practice with regard to volume and choice of intravenous fluid. It is important that perioperative practitioners have an understanding of intravenous fluid, fluid compartmentalisation, fluid mechanics and intravascular fluid control mechanisms. Optimum fluid status not only shortens hospital stay but also reduces the incidence of postoperative nausea and vomiting and complication profiles. This article aims to provide perioperative practitioners with a comprehensive overview of fluid management. It will cover important issues surrounding physiological control of fluid balance, choice of intravenous fluid therapy, methods to monitor intravascular volume and factors which influence delivery.

The impact of the National Patient Safety Agency intravenous fluid alert on iatrogenic hyponatraemia in children

2009 ◽  
Vol 169 (7) ◽  
pp. 813-817 ◽  
Author(s):  
Simon B. Drysdale ◽  
Timothy Coulson ◽  
Natalie Cronin ◽  
Zita-Rose Manjaly ◽  
Chinthika Piyasena ◽  
...  
Keyword(s):  
Patient Safety ◽  
Intravenous Fluid ◽  
National Patient Safety Agency ◽  
National Patient ◽  
The Impact

Standardizing the Early Identification of Acute Kidney Injury: The NHS England National Patient Safety Alert

Nephron ◽  
2015 ◽  
Vol 131 (2) ◽  
pp. 113-117 ◽  
Author(s):  
Nicholas M. Selby ◽  
Robert Hill ◽  
Richard J. Fluck ◽  
Keyword(s):  
Acute Kidney Injury ◽  
Patient Safety ◽  
Early Identification ◽  
Kidney Injury ◽  
Safety Alert ◽  
National Patient

Steroid emergency cards: action needed

2020 ◽  
Vol 58 (11) ◽  
pp. 163-163
Keyword(s):  
Patient Safety ◽  
Early Recognition ◽  
Adrenal Crisis ◽  
Safety Alert ◽  
National Patient

AbstractOverview of: NHS England, 2020. National Patient Safety Alert—Steroid Emergency Card to support early recognition and treatment of adrenal crisis in adults.

scholarly journals ‘Take Ten’ improving the surgical post-take ward round: a quality improvement project

2018 ◽  
Vol 7 (1) ◽  
pp. e000045 ◽  
Author(s):  
Danielle Alice Banfield ◽  
Carly Adamson ◽  
Amy Tomsett ◽  
James Povey ◽  
Tony Fordham ◽  
...  
Keyword(s):  
Patient Safety ◽  
Length Of Stay ◽  
Management Plan ◽  
Ward Round ◽  
Nutrition Status ◽  
Surgical Patient ◽  
Improvement Project ◽  
Team Members ◽  
Diagnosis And Management ◽  
Management Plans

BackgroundThe surgical post-take ward round is a complex multidisciplinary interaction in which new surgical patients are reviewed and management plans formulated. Its fast-paced nature can lead to poor communication and inaccurate or incomplete documentation with potential detriment to patient safety. Junior team members often do not fully understand the diagnosis and management plan.AimsThe aims of this project were to improve both communication and documentation on the surgical post-take ward round, influencing patient safety.MethodsThe ward round was deconstructed to identify individual roles and determine where intervention would have the most impact. Ten important points were identified that should be documented in the management of an acute surgical patient; observations, examination, impression, investigations, antibiotics, intravenous fluids, VTE assessment, nutrition status, estimated length of stay and ceiling of treatment. A ‘Take Ten’ checklist was devised with these items to be used as a ‘time out’ after each patient with the whole team for discussion, clarification and clear documentation. Four plan do study act cycles were completed over a period of a year. A retrospective review of post-take documentation preintervention and postintervention was performed, and the percentage of points that were accurately documented was calculated. For further clarification, 2 weekends were compared—one where the checklist was used and one where it was not.ResultsResults showed documentation postintervention varied between categories but there was improvement in documentation of VTE assessment, fluids, observations and investigations. On direct comparison of weekends the checklist showed improved documentation in all categories except length of stay. Junior team members found the checklist improved understanding of diagnosis and management plan, and encouraged a more effective ward round.ConclusionThe ‘Take Ten’ checklist has been well received. Three years on from its inception, the checklist has become an integral part of the post-take ward round, thanks to the multidisciplinary engagement in the project.

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