GP216 An audit of maintenance intravenous fluid therapy in the paediatric general wards at mater dei hospital, malta

Background Intravenous fluids are one of the most frequently prescribed drugs in hospital, and yet the practice continues to fall short of National Institute for Health and Care Excellence (NICE) guidelines. Paediatric patients are particularly vulnerable to complications of intravenous fluid therapy. Aims, objectives and standards We aim to better prescribing practices of intravenous fluid prescription and fluid balance monitoring by staff in the paediatric wards, and to make recommendations and carry out interventions to improve areas where the adherence to NICE guideline ‘Intravenous fluid therapy in children and young people in hospital’, published in December 2015, is poor, as identified by the first cycle of the audit. Methodology Data was collected prospectively from the notes of patients aged 0 to 16 years admitted in the two general paediatric wards at Mater Dei Hospital over a four month period. Patients started on intravenous maintenance fluids were included. Data included which fluid was prescribed, the indication, prescription practices, input and output charting and monitoring of serum electrolytes and glucose. Children with diabetic ketoacidosis and renal or hepatic disease were excluded. Results A total of 65 patients were included. In only 5% of the treatment charts reviewed was the maintenance intravenous fluid prescribed, despite there being a specific section for fluid prescription. Actual weight was recorded on 89% of the drug charts. Estimated weight was documented in the remaining 11%. 81% of calculations of infusion rate on actual weight were performed correctly according to the Holliday-Segar formula. 100% of patients were administered 5% dextrose in 0.45% saline, as per local availabilities. On admission, U&Es were checked in 97%, and blood glucose in 79% of patients. However, U&Es were only checked in 31% and blood glucose in 14% of the patients still on maintenance fluids 24 hours later. Fluid input and output charting was documented in 94% of patients, but in only 19% of these patients were subtotals written every 24 hours. The standard charts used at Mater Dei Hospital do not have a section for 12 hourly documentation. Conclusion Staff within the department must be educated regarding the need for improved intravenous fluid prescription and the importance of conducting daily U&Es and blood glucose input and output monitoring. Documentation of input and output must also be improved. The input and output charting form needs to be reviewed to include 12 hourly subtotals.