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Improving the Safety and Efficiency of Intravenous Fluid Prescribing for Adults E. Tenison, K. Leonard, A. Cumpstey, S. de Courcy, A. Foster, H. Mackinnon, K. Nelson-Smith, S. Walter, H. Yilmaz, E. Greig, M. Walburn Wednesday 12th June 2013 NACT/UKFPO Foundation Programme Sharing Event Fluid Prescribing • Morbidity + mortality • 9% of prescription errors “Fluid management…should be accorded the same status as drug prescription” (NCEPOD) (GMC EQUIP) Our Experience • Undergraduate teaching • “Learn as you go along” • Life as an F1 Initial research 1) Questionnaire 3) Appropriateness Weight- 56% never check 11% Fluid status- only 12% always check indicated U+Es- only 28% always check not indicated 89% 2) On call survey 55%- could safely have been prescribed by EXCESS Na+ 83% day team 22%- could have been stopped prior to OOH request’ INSUFFICIENT K+ 85% Developing the Aim Driver Diagram Effectiveness Effectiveness Safety Patient centeredness Timeliness and Efficiency Developing a Fluid Prescribing Tool BATCH NUMBER removed Current Progress • Changing culture • Education • Widespread hospital involvement • Trialing fluid chart • Feedback • Further PDSA cycles Feedback • • • • • Indication Clinical assessment box Continue/stop/review U+Es Guidance on the back We often waste time bleeping the doctor because the bag has finished when they didn't want more fluids anyway! • Clarify ‘clinical assessment’ box • More space to write fluid/additive • Space for 2nd nurse to countersign It doesn’t need to be perfect because it is a huge improvement on what we have at the moment The next steps… • Measure the impact of intervention • Teaching • Future plans – Fluid balance chart – IV fluid teaching programme for FY1s – Paediatrics – Other trusts? THANK YOU ANY QUESTIONS? References • • • • • • The Health Foundation: Quality improvement made simple- what every board should know about healthcare quality improvement Dorman et al. EQUIP study. An in depth investigation into causes of prescribing errors by foundation trainees in relation to their medical education. Powell-Tuck, J et al. British Consensus Guidelines on Intravenous Fluid Therapy for Adult Surgical Patients . GIFTASUP. March 2011. Thong Lim et al. Intravenous fluid prescribing practices by foundation year one doctors – a questionnaire study. R Soc Med Sh Rep 2012;3:64. Extremes of Age: the 1999 National Confidential Enquiry into Peripoperative Deaths Intravenous fluid therapy in adults in hospital. NICE guidance: draft for consultation. May 2013.