IV fluids guidelines should improve outcomes for patients
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NICE has recently published guidance calling for more careful management of drips or IV fluids in hospitals. Mismanagement of IV fluid therapy can cause serious harm and damage to often very unwell patients.
The recommendations include the appointment of an IV fluids lead or champion with overall responsibility for training, overseeing and reviewing IV fluids management and prescribing outcomes. The guidelines also make clear that the administration of drips is not left to the most junior doctors but is actually performed by healthcare professions competent assessing the fluid needs of the patient with the ability to prescribe and administer fluids and monitor outcome. In addition, incidents of fluid mismanagement should be reported as critical incidents.
It is acknowledged that currently training on prescribing and administering IV fluid therapy is not sufficient and is often too general and not related to administration in acute settings. The Guidelines published in December 2013 include the use of the five Rs of IV fluid therapy:
- Routine maintenance;
- Redistribution and
These are to assist in making decisions over a patient's requirement for fluid therapy, what should be prescribed and the duration of the therapy and most importantly the need to reassess patients at regular intervals.
Failure to manage IV fluid therapy properly can have serious consequences for patients. The National Confidential Enquiry into Perioperative Deaths 1999 reported that as many as one in five patients on IV fluid therapy may experience complications as a result of being given too much, too little or the wrong type of fluid. Such complications can prove to be fatal but such outcomes could be avoidable with proper management and training.
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