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To National Patient Safety Agency or not to National Patient Safety Agency: an audit on the current trends in paediatric intravenous fluid prescribing for surgical patients
  1. Junaid E Birmingham
  1. Children's Hospital NHS Foundation Trust, Birmingham, UK

Abstract

Objective To audit intravenous fluid prescribing for surgical patients against Birmingham Children's Hospital inhouse intravenous prescribing guidelines and national guidance.1 2

Method A retrospective analysis of patient drug charts and medical records (including electronic biochemical records) on two general surgical wards during a 5 day working week. The following details were recorded: consultant team, procedure undertaken, type of intravenous fluid prescribed, the rate prescribed, does it contain potassium and if so the concentration prescribed, weight of the patient and number of times patient was re-weighed, duration of intravenous fluid prescribed, frequency of monitoring for sodium and potassium levels while on intravenous fluids. The data was analysed using Microsoft Excel 2007.

Results 25-patients were reviewed from 17 consultant teams from different specialities. More than half of the intravenous fluids prescribed were by a surgical team (56%). The average age of patients was 4 years and 4 months (range: 3 weeks to 16 years) and 60% of the patients were female. The average weight was 16.25 kg (range: 3.56 kg–53 kg). In terms of monitoring for sodium and potassium levels, about 35% of patients were not monitored. In terms of the rate prescribed, 44% of patients were prescribed an incorrect rate with no reason why the rate was prescribed. All patients were initially weighed on admission but none of the patients were re-weighed daily while on intravenous fluids.

19 (75%) of patients assessed for appropriate intravenous fluid prescribing did not comply with local and national guidance and failed to meet the standards for this audit. 92% of patient were prescribed incorrect fluid type postoperatively in relation to local guidance,1 however 100% of patients complied to national standards2 for peri-operative fluid choice and 28% of patients with a low sodium episode had no changes to their intravenous fluid type prescribed.

Conclusion Inconsistencies in prescribing were identified in all consultant teams. These mainly included the choice of fluid, the rate prescribed, lack of monitoring and lack of weight monitoring in all cases. This raises the risk of injury to the patient from hospital-acquired hyponatraemia. Training needs to be improved within all consultant teams prescribing intravenous fluids to improve current trends and to adhere to local and national guidance, in order to reduce this potential risk.2

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