Intravenous fluid use in the acutely unwell adult medical inpatient: Improving practice through a clinical audit process

Abstract

Background: Our Trust developed a clinical guideline to improve the prescribing and use of intravenous (IV) fluids based on the British consensus guidelines on IV fluid therapy for adult surgical patients. We audited the effect of targeted interventions to improve performance against this guideline. Method: There were 53 IV fluid prescription charts in the pre-intervention audit and 48 in the post-intervention audit. Data was collected on the seven local practice standards ('local gold standards') in the clinical guideline; compliance with all of them was necessary to meet the IV fluid prescribing bundle of care. Results: The proportion of prescriptions which met the IV fluid prescribing bundle of care increased (3.8% to 22.9% [p=0.004]) and the legibility of the IV fluid prescription increased (28.3% to 56.3% [p=0.004]). Conclusion: We have shown that the process of prescribing, administering and monitoring IV fluid use can be significantly improved through a range of targeted multi-disciplinary interventions. © 2012 Royal College of Physicians of Edinburgh.