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Neil Soni speaks on ensuring appropriate use of IV therapy in line with the recent NICE Guideline

Neil SoniNeil Soni

Neil began the presentation by focusing on fluid management as an essential, frequently unavoidable and important part of Hospital treatment. Despite being integral to management training of medical and nursing staff in fluid management has been vague and haphazard and is usually handed down rather than taught. Senior medical involvement outside of specialist units is rare.  Complications are not to be common yet there is little data to support this statement as it has rarely been audited. 

Neil advised the NICE guidelines is the first step in correcting this anomaly in health care. Furthermore, they are aimed at junior doctors and nurses as the individuals who are most likely to be involved and provide basic guidance on the principle and practice of fluid management that should help standardise this in the UK. They are not intended to dictate to specialist units or specialities where fluid management is their specialist area but rather are for general use. The main problem is in the wards and that is what needs correcting. 

The presentation went on to explore the advice is physiology based and key to all fluid management is the concept of assessment not rote, and regular reassessment. The practical application can be summarised as the 5 R’s. Resuscitation, routine maintenance, replacement, redistribution and reassessment. There are appropriate algorithms for each and these provide a basis for understanding and a framework for management. 
Identification and recognition of complications is emphasised as is the need to record and audit fluid management. This is long overdue as standard practice. Teaching and training of all health care professionals who prescribe or manage IV fluids needs to be formalised initially by recognising its importance. The guidelines provide common pathway for education. To achieve this in an Institution will require leadership and investment and so appointing a responsible person to lead is important. 

Neil concluded the presentation with discussing the Guidelines do not pretend to be a complete  fix  of the problem. They provide  a sound basis for changing the cultural approach to fluids in the wards, to recognising the importance of doing it well and the problems with doing it badly. It takes time to alter behaviour but it is a start. To be successful requires compliance with the guidelines but they are simple and easy to understand and along with education and audit should be a good start to sorting out a major previously ignored yet fundamentally vital part of hospital management.  

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Download: Neil Soni's Presentation

17 September 2014

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