10 December 2013

NHS Patients on Drips at Risk of Serious Errors

Patients' lives are being put at risk because of errors in intravenous (IV) fluid care, warns NICE.

Despite being an extremely common treatment, a lack of training for healthcare professionals has resulted in patients receiving too much or too little fluid, or even the wrong type of fluid.

It is thought 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.

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

To address the situation, NICE has produced a clear step-by-step algorithm outlining the fluids a patient may require and is urging healthcare professionals to start considering fluids as drugs.

Any healthcare professional prescribing IV fluids should remember the ‘five Rs' of IV fluid management: resuscitation, routine maintenance, replacement, redistribution and reassessment.

NICE recommends that hospitals identify an IV fluids champion who can lead of ensuring best IV fluid practice and deliver training and auditing of IV fluid prescribing and patient outcomes.

Dr Mike Stroud, Consultant in Gastroenterology and General Medicine at Southampton University Hospitals NHS Trust and Chair of the group responsible for the guidance, said: “I estimate that tens of thousands of patients will have a complication related to IV fluids every year.

“It is astonishing really that doctors are not well educated in fluid therapy, but because it is not a speciality it has fallen through the cracks.

“This new NICE guideline has training and education at its heart and will play a vital role in making sure that staff at all levels in the NHS deliver consistent, high-quality care for all patients.”

Dr Stroud added that following the Francis Inquiry into the failings at Mid Staffordshire Hospital, ensuring patients receive correct fluid therapy takes on even greater importance.

“This is a fundamental of safe care and needs to be done well to avoid complications,” he said.

Professor Mark Baker, Director of the Centre for Clinical Practice at NICE, said: “The care of a patient needing IV fluid therapy can vary considerably depending on where they live and this new guideline will go a long way in helping support healthcare professionals to provide the best level of care.”

“We are working with organisations including the General Medical Council and the Medical Schools Council and have commissioned the Centre for Pharmacy Postgraduate Education to develop an online learning tool so that all medical professionals receive formal training and education on this topic.”

Elsewhere, the guideline recommends that starch-based fluids should not be used for fluid resuscitation. This follows a move by the Medicines and Healthcare Regulatory Agency (MHRA) to suspend the licenses for hydroxyethyl starch products following safety concerns.

Dr Jerry Nolan, Consultant in Anaesthesia and Intensive Care Medicine for the Royal United Hospital Bath NHS Trust who also helped develop the guidance, said: “The evidence highlighted that tetrastarches offer no clear benefit over other IV fluids, are associated with a small increased risk of death and are also more costly than saline-based IV fluids called crystalloids.”

A quality standard on IV therapy in adults in hospitals is already in development and is expected to be published in the summer of 2014.