Dr Ru New is a Basic Physician Trainee working at the Townsville Hospital. She completed Bachelor of Medicine and Surgery (MBBS) in the University of Adelaide in 2010, practised in Malaysia for 2.5 years before returning to South Australia where she worked in the Lyell McEwin Hospital from year 2013 to 2018. She completed FRACP Part 1 Examinations in year 2018.
Intravenous Fluid Prescription In An Australian Tertiary Hospital
Background: Intravenous fluid (IVF) is one of the most common interventions prescribed to hospital inpatients1. Prescription error is common2,3 and could lead to serious complications1. To optimise the quality of IVF prescription for medical inpatients in Lyell McEwin Hospital, the Northern Adelaide Local Health Network (NAHLN) Intravenous Fluid and Electrolyte Prescription in Adults Policies, Procedures & Guidelines (PPG) has been developed.
Aim: The aim was to investigate adherence of IVF prescription to the local guidelines before and after education session.
Methods: We performed retrospective study of 63 Acute Medical Unit inpatients in April 2015 (baseline audit) and 52 General Medical ward inpatients in July 2016 (follow up audit) who met the inclusion criteria. The exclusion criteria were patients admitted for stroke, diabetes ketoacidosis or hyperosmolar hyperglycaemic state, patients who required care from intensive care unit, and those with end-stage renal failure. Parameters analysed included indication, content, rate and volume, assessment and monitoring of fluid status and electrolytes, as well as correct use of the inpatient IVF prescription chart. Collected data was presented in percentages and where applicable, partition modelling and Chi square analysis were utilized.
Results: Majority of IVF prescription did not have any indication of the therapy documented (68% in baseline audit, 58% in follow up audit). 90.4% patients had assessment of fluid status completed prior to commencement of IVF. Normal saline was the most commonly prescribed IVF (81.94% in baseline audit, 74.72% in follow up audit). There has been improvement in monitoring of serial electrolyte (from 25.4% to 88.5%) and serial weight measurement (from 3.2% to 11.5%); however, completion of fluid balance chart remains inadequate.
Conclusion: Although there has been improvement in monitoring of weight and electrolyte after IVF therapy, overall adherence to the IVF prescription PPG remains suboptimal and ongoing education to increase awareness is recommended.