2 September 2014

Hospitals Urged to Tackle Incorrect Use of Drips

Every hospital should appoint an intravenous (IV) fluids lead to help ensure that patients receive the correct dosage and type of fluid, says NICE.

This follows concerns that as many as 1 in 5 patients on IV fluids and electrolytes suffer complications due to inappropriate administration, according to figures from the National Enquiry into Perioperative Deaths report.

Errors in prescribing IV fluids and electrolytes are particularly likely in emergency departments, acute admission units, and general medical and surgical wards.

Too much fluid can lead to problems such as pneumonia and heart failure, while too little fluid can damage the kidneys.

NICE’s latest quality standard recommends that hospitals have an IV fluids lead who has overall responsibility for training, clinical governance, audit and review of IV fluid prescribing and patient outcomes.

The IV fluids lead in a hospital should be someone in a senior position, such as the chief of medicine or chief nurse, and should look to  promote best practice, ensuring that healthcare professionals are trained in prescribing and administering IV fluid therapy, and reviewing learning from ‘near miss’ and critical incident reporting.

Despite being an extremely common treatment, IV fluid management in hospitals is often delegated to the most junior medical staff who frequently lack the relevant experience and may have received little or no specific training on the subject.

To address this, NICE recommends that adults receiving IV fluid therapy in hospital should be cared for by healthcare professionals competent in assessing patients’ fluid and electrolyte needs, prescribing and administering IV fluids, and monitoring patient response.

An IV fluid management plan, determined by and reviewed by an expert, which includes the fluid and electrolyte prescription over the next 24 hours and arrangements for assessing patients and monitoring their plan should be drawn up for all adults receiving IV fluid therapy in hospital.

Any clear incidents of fluid mismanagement in adults who receive IV fluid therapy in hospital should be reported as critical incidents, according to the quality standard.

Professor Gillian Leng, Deputy Chief Executive and Director of Health and Social Care at NICE, said: “Our quality standards aim to help healthcare professionals in the NHS pinpoint the areas where improvements are most needed to provide the best care for patients. With the new standard for IV fluid therapy, we hope to make sure that every patient, wherever they are, can be confident that they will be treated safely and effectively during their stay in hospital. With our standard for varicose veins, we are highlighting the right tools and treatments healthcare professionals should use to help improve symptoms for affected patients.”

Quality standards recognise the important role families and carers have in supporting adults in hospital receiving IV fluid therapy. If appropriate, healthcare professionals should ensure that family members and carers are involved in the decision-making process about investigations, treatment and care.