title: Safer fluid prescribing at North Bristol Trust: Bringing practice in line with NICE Guidance with a redesign of the fluid prescription chart.
abstract: The National Institute of Clinical Excellence (NICE) released new fluid guidelines following data suggesting 20% of patients receiving fluids suffer adversely (2013). This quality improvement group assessed fluid prescribing in a tertiary teaching centre and introduced a new fluid- prescribing chart to align practice with NICE recommendations. Notes and corresponding fluid prescription charts were reviewed for evidence of (1) indication, (2) co-morbidities, and (3) further management as surrogate markers of safe prescribing in accordance with NICE. Overall, the data showed practice fell short and prompted a redesign of the Trust fluid prescription chart. Three different variations of the chart were issued consecutively using a PDSA method (plan, do, study, act) over a 6-month period. They all included indication, co-morbidities and further management plans as constant design features. Suggestions from interested parties were incorporated and an educational programme was implemented to promote awareness. Prior to our intervention, an indication for fluids was documented in 26% of notes, it took an average of 4.6 minutes to find co-morbidities, and further management plans were rarely documented. Following the new prescription chart, an indication was recorded in 72% of cases, co-morbidities noted on 63% of charts with 93.1% accuracy, and further management documented in 100% of cases. The new fluid prescription chart encourages prescribers to incorporate NICE recommendations when prescribing fluids. The new fluid prescription design has since been rolled out Trust wide.
authors.affiliation: North Bristol Trust.
authors.forename: Johanna
authors.initials: J
authors.lastname: Andersson
authors.affiliation: North Bristol Trust.
authors.forename: Thomas
authors.initials: T
authors.lastname: Bull
authors.affiliation: North Bristol Trust.
authors.forename: Daniel
authors.initials: D
authors.lastname: Paul
authors.affiliation: North Bristol Trust.
authors.forename: Emily
authors.initials: E
authors.lastname: Reynolds
authors.affiliation: North Bristol Trust.
authors.forename: Aimi
authors.initials: A
authors.lastname: Nishimura
authors.affiliation: North Bristol Trust.
authors.forename: Jessica
authors.initials: J
authors.lastname: Lloyd
authors.affiliation: North Bristol Trust.
authors.forename: Amanda
authors.initials: A
authors.lastname: Jetley
authors.affiliation: North Bristol Trust.
authors.forename: Mari
authors.initials: M
authors.lastname: Davies
authors.affiliation: North Bristol Trust.
authors.forename: Helen
authors.initials: H
authors.lastname: Eisenhauer
authors.affiliation: North Bristol Trust.
authors.forename: Daniel
authors.initials: D
authors.lastname: Maggs
authors.affiliation: North Bristol Trust.
authors.forename: Sorcha
authors.initials: S
authors.lastname: Clapham
authors.affiliation: North Bristol Trust.
authors.forename: Kaushali
authors.initials: K
authors.lastname: Trivedi
authors.affiliation: North Bristol Trust.
authors.forename: Robert
authors.initials: R
authors.lastname: Hair
authors.affiliation: North Bristol Trust.
authors.forename: Benjamin
authors.initials: B
authors.lastname: Plumb
authors.affiliation: North Bristol Trust.
authors.forename: Benjamin
authors.initials: B
authors.lastname: Plumb