Prescription of Intravenous Fluid for Administration in Children

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. The 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%.

Aims

An area of weakness was identified from the initial audit. Areas identified for improvement were fluid balance, daily weights, potassium content in IV fluids and renal function monitoring. 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 these outcomes and ensure patient safety.

Making the Case for Change

We took the following 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 clinicians as well as nursing staff during departmental meetings 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.

Our Improvement

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.

Learning and Next Steps

This project highlights the importance of regular education of staff.

This project was approved by the local Trust. 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.

Project lead: Dr S Deepak and Dr Tinklin (supervisor)

Organisation: Royal Derby Hospital, Derby, UK