title: An audit of intravenous fluid prescribing and plasma electrolyte monitoring; a comparison with guidelines from the National Patient Safety Agency.
abstract: OBJECTIVE
  To audit past practice of intravenous (i.v.) fluid prescribing and electrolyte monitoring, prior to the publication of guidelines by the National Patient Safety Agency (NPSA, Ref. NPSA/2007/22) in March 2007, highlighting areas of discrepancy, in a specialist children's hospital.
  
  
  METHODS
  We performed a retrospective case note review of 100 appendectomy patients between February 2004 and March 2007, recording; fluid type and volumes given as maintenance therapy, resuscitation boluses and nasogastric replacement; the frequency and timing of plasma electrolyte measurement; the relationship between plasma sodium [Na] concentration and i.v. fluid prescribed; and patient weight recordings.
  
  
  RESULTS
  Ninety-eight acute appendectomies and two interval elective appendectomies. Median age 10 years (interquartile range: 8-11.25). Before surgery, hypotonic maintenance fluid was prescribed for 94% patients. During surgery, maintenance fluid was predominantly isotonic. After surgery, hypotonic maintenance fluid was prescribed for 92% patients. All maintenance fluid volumes were appropriately calculated according to weight using the Holliday and Segar formula (Paediatrics, 19, 1957, 823). Fluid boluses were isotonic on 128/129 occasions and all accurately calculated according to weight. Nasogastric losses were replaced with 0.9% sodium chloride. No patient had daily plasma electrolyte measurements whilst administered i.v. fluid. Twenty-seven patients had recorded hyponatremia ([Na] <135 mmol x l(-1); 21 at presentation, six subsequently after admission). Hypotonic maintenance fluid was continued in 26/27 patients with hyponatremia. No patient had daily weight recorded.
  
  
  CONCLUSIONS
  Our practice of i.v. fluid prescribing and electrolyte monitoring in children, prior to the publication of guidelines by the NPSA in March 2007, did not fully meet the recommended standards.
authors.affiliation: The Royal Hospital for Sick Children, Women's and Children's Directorate, NHS Greater Glasgow and Clyde, Dalnair Street, Yorkhill, Glasgow, UK. rosiesnaith@doctors.org.uk
authors.forename: Rosie
authors.initials: R
authors.lastname: Snaith
authors.forename: Jane
authors.initials: J
authors.lastname: Peutrell
authors.forename: David
authors.initials: D
authors.lastname: Ellis
mesh_terms: D000293:Adolescent; D001062:Appendectomy / Q000009:adverse effects; D002648:Child; D002675:Child, Preschool; D054976:Clinical Governance; D004739:England; D005260:Female; D005440:Fluid Therapy / Q000379:methods / Q000592:standards*; D019983:Guideline Adherence; D017408:Guidelines as Topic; D006801:Humans; D007010:Hyponatremia / Q000139:chemically induced / Q000517:prevention & control*; D007038:Hypotonic Solutions; D007262:Infusions, Intravenous; D008297:Male; D008485:Medical Audit; D008991:Monitoring, Physiologic / Q000592:standards; D019990:Perioperative Care; D012189:Retrospective Studies; D012964:Sodium / Q000097:blood; D012965:Sodium Chloride / Q000008:administration & dosage* / Q000009:adverse effects; D014852:Wales
chemical_list: D007038:Hypotonic Solutions; D012965:Sodium Chloride; D012964:Sodium