Transcript Improving the Safety and Efficacy of Fluid Prescribing in

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
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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
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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.