Background Since the year 2000 there have been four child deaths and one near miss following neurological injury as a result of hospital-acquired hyponatraemia reported in the UK, and international literature has also cited more than 50 cases of serious injury or child death from the same cause. As a result a National Patient Safety Alert (NPSA) alert was published in 2007 advising healthcare organisations on how to minimise the risks associated with administering intravenous (IV) infusions to children.
Aims and objectives The aim was to audit the compliance of prescribers with local and national guidelines on the prescribing of IV fluids in paediatric patients. Audit standards were set with an expected compliance of 100%. These included documentation of patient weight, maintenance fluid calculation, volume and rate, and prescriber signature. Infusion fluids should have been prescribed in accordance with the NPSA alert and local guidelines, and U&E's should be monitored on admission and 24 hourly with the reassessment and monitoring section of the medication chart fully completed.
Methodology The audit looked prospectively at a sample of paediatric medication charts for children aged 1 month to 16 years. Data was collected from two paediatric wards and a total of 45 patients were audited. Indigo review was used to check monitoring of U&E's. Children with Diabetic Ketoacidosis, liver, renal and burns patients were excluded from the audit due to their differing fluid and electrolyte requirements.
Results Weight was documented on 100% of the drug charts. Calculation of maintenance fluid volume was recorded on 49% of drug charts, and 91% of these calculations were performed correctly. When fluid deficit was required it was recorded and calculated correctly on 100% of the medication charts. The choice of IV maintenance fluid complied with local and national guidelines (100%); however fluid deficit was given as sodium chloride 0.45%/5% dextrose. Infusion rate was documented (100%), however only calculated correctly in 84% of cases due to incompliance with maximum daily fluid allowance. The reassessment and monitoring table was completed on 0% of the drug charts, however according to Indigo review U&E's were checked on admission (100%), but only checked on a daily basis in 24% of the patients.
Conclusion Based on the objectives set, not all of the standards achieved 100% compliance. Prescribers need to be educated on paediatric IV fluid prescribing, and the importance of conducting daily U&E monitoring. The IV fluid section on paediatric drug charts also needs to be reviewed to enhance the ease of prescribing IV fluids correctly to prevent hospital induced hyponatraemia and enhance patient safety.
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