NICE guideline and quality standards for IV fluid therapy
Katie Scales Consultant Nurse Critical Care Imperial College Healthcare NHS Trust and Member of NICE CG 174 Guideline Development Group & Advisory Committee member for NICE Quality Standard 66 spoke at today’s Advancing IV Therapy conference on
Why the Guideline and Quality Standards are needed
10 key priorities for implementation
In her presentation Katie stated:
'Assess your patient first, then decide what you are doing' 'It should be a strategy not a knee jerk reaction'
'You can start with your guidance, but you need to review it every 24 hours'
'Deciding on who the IV therapy lead should be in your practice, this should be someone at board level - clinician based'
Abstract of Katie’s presentation:
Intravenous (IV) fluid therapy is an essential part of modern healthcare, it has been estimated that at least 90% of hospitalised patients will receive IV fluid therapy at some point during their hospital stay. IV fluids are prescribed and administered daily, in all specialties, across the NHS. Despite our familiarity with IV fluid therapy little attention is given to this important topic within the undergraduate curriculum. Most health professionals know little about IV fluid therapy at the point of registration and rarely re-visit this topic during their professional careers.
In 1999 the National Confidential Enquiry into Perioperative Deaths identified that a significant number of patients were dying due to the over or under prescription of IV fluids. The report recommended that fluid management “should be accorded the same status as drug prescription”, a recommendation that is yet to be achieved in clinical practice. The risk of harm from inappropriate fluid management is estimated to affect 1 in 5 patients.
Health professionals often have little knowledge of the fluid and electrolyte needs of their patients and also know little about the composition of the IV fluids and electrolytes that are commonly prescribed and administered. IV fluid prescribing is often based on habit rather than evidence and is often the left to the most junior and least experienced member of the team. Health professionals may not recognise the link between poor fluid management and patient morbidity or mortality. Patients who receive too much fluid may go on to develop pulmonary oedema, which predisposes patients to pneumonia, which in turn may lead to prolonged hospitalisation or even death, particularly in the elderly. Patients who receive too little fluid are at risk of hypotension and acute kidney injury, which also increases length of hospital stay and overall risk of long term kidney damage. The time that elapses between an episode of fluid mismanagement and a patient’s eventual mortality often separates the cause and effect and professionals may fail to recognise the part that fluid therapy has played in the patient’s outcome.
The need for IV fluid guidelines is clear. All health professionals must be competent to prescribe, administer and monitor IV fluid and electrolyte therapy. The NICE IV fluid therapy guideline includes a range of useful resources to help health professionals to correctly assess and monitor the fluid and electrolyte needs of their patients.
Resources are available on the following links:
NICE IV Fluid therapy Full Guideline http://www.nice.org.uk/guidance/cg174/evidence/intravenous-fluid-therapy-in-adults-in-hospital-full-guideline-191667997
NICE IV Fluid therapy Full Guideline - summary https://www.nice.org.uk/guidance/cg174/resources/intravenous-fluid-therapy-in-over-16s-in-hospital-35109752233669
Algorithms for IV Fluid therapy in adults http://www.nice.org.uk/guidance/cg174/resources/intravenous-fluid-therapy-in-adults-in-hospital-algorithm-poster-set-191627821
Diagram of on-going losses http://www.nice.org.uk/guidance/cg174/resources/diagram-of-ongoing-losses-191664109
Katie Scale’s full presentation is available for download at the end of this page.
Katie Scale’s Biography:
Katie is a Consultant Nurse in Critical Care at Imperial College Healthcare NHS Trust and leads a nurse-led Outreach service providing critical care support to acutely ill adults in general wards.
Katie has an extensive career in critical care nursing and education. She was clinical tutor to the ITU course at St Thomas’ Hospital, London and a university lecturer with the Nightingale Institute before returning to clinical practice in 1995. In 1997 Katie was appointed Assistant Director of Nursing at the Hammersmith Hospitals NHS Trust before becoming a first wave Consultant Nurse in July 2000, the post she still holds today.
Katie has had a career-long interest in intravenous therapy and was a committee member of the RCN’s IV Therapy Forum for many years and a co-author of all three editions of the RCN’s Standards for Infusion Practice. Having been a founding board member of NIVAS, the multi-professional National Infusion and Vascular Access Society, Katie stepped down from the board in November 2014. Katie provides expert advice to the MHRA and is the nurse member of the Injectable Medicines Guide Group. Katie is a member of the Editorial Advisory Board of Nursing Standard and a manuscript reviewer for Nursing Standard. Katie presents and publishes widely in the field of intravenous therapy.
Katie was a member of the NICE Guideline Development Group and the NICE Quality Standards Advisory Committee for intravenous fluid therapy in adults in hospital.
Future conferences of interest:
Nursing Appraisal and Revalidation & implementing the New NMC Code of Practice
Effective Ward Manager
Nursing Revalidation Preparing for Going Live
Advancing IV Therapy
Download: katie-scales_1267.pdf3 December 2015