61 Improving IV fluid prescription in newcastle, UK – a trainee doctor led quality improvement project. (12th November 2018)

• Record Type: Journal Article
• Authors: Samuel, Robert; Laws, Phil
• Is Part Of: BMJ leader. Volume 2(2018)Supplement 1
• Page Start: A25
• Page End: A25
• Publication Date: 2018-11-12
• Subjects: Medical personnel -- Periodicals; Leadership -- Periodicals; Medicine -- Practice -- Management -- Periodicals; Health services administration -- Periodicals; 610.68
• DOI: 10.1136/leader-2018-FMLM.59
• Languages: English
• ISSNs: 2398-631X

Abstract

Abstract : Aims: The aim was to improve the prescription of intravenous (IV) fluids in the emergency department, medical wards and surgical wards using principles of leadership and service improvement. Methods: The proposed change to practice was to introduce a new IV fluid prescription sheet that contained decision-aids that closely matched the most recent NICE guidelines on IV prescription in adults. The change was assessed in three ways. Firstly, the NICE clinical audit tool for IV fluid prescription in adults was performed before and during the pilot period by junior doctors working in the acute medical unit (AMU). Secondly, electronic records for sodium and potassium blood results were measured for the first 7 days of admission both before and during the intervention. Chi-square test was used to test for significance. Thirdly, a feedback sheet was put up in the nursing and non-medical staff room for comments on the intervention. Principles of trainee doctor leadership such as early senior medical staff buy-in, multi-disciplinary involvement and qualitative feedback were used. Results: There was a statistically significant reduction in rates of hypokalaemia, defined as a potassium result below the reference range, for the first 7 days following admission to hospital via the AMU. There was a mixed response to the NICE Clinical Audit tool, with improvements in some areas and reductions in others. Qualitative feedback helped discover issues with the sheet not previously identified. Conclusions: It is possible to lead a service improvement project as a foundation trainee. The principles of medical leadership and service improvement genuinely help to make small ideas into reality. This project shows that small simple changes to frequently performed tasks in a hospital have the potential to impact patient safety. The trial fluid prescription sheet is being used to inform the implementation and design of electronic IV fluid prescribing within the trust.