Manas Atre
Introduction
Intravenous fluid therapy is a critical component of post-operative care. Inappropriate prescribing or monitoring can contribute to complications including acute kidney injury and electrolyte imbalance. The National Institute for Health and Care Excellence guideline CG174 outlines standards for safe intravenous fluid prescribing and monitoring. Local concerns suggested inconsistent documentation of post-operative intravenous fluid management in surgical patients.
Methods
A closed-loop audit was conducted in the General Surgery department at Wye Valley NHS Trust. Twenty elective post-operative patients were reviewed over a two-week period. Compliance with NICE CG174 standards was assessed for four parameters: presence of intravenous fluid prescription, documentation of indication, completion of fluid balance charts, and documentation of daily fluid review in medical notes. Following baseline analysis, targeted interventions were introduced including junior doctor teaching, awareness posters in ward areas, and addition of a “Fluids reviewed” tick-box to the daily handover sheet. A second audit cycle was performed four weeks later using the same methodology.
Results
Baseline compliance demonstrated documentation gaps: intravenous fluid prescription present in 40% of patients, indication documented in 64%, fluid balance chart completed in 60%, and daily review documented in 36%. Following interventions, fluid balance chart completion improved to 100% and documentation of daily review increased to 70%. Fluid prescription documentation was 30% and indication documentation 40% in the re-audit cycle.
Conclusions
Targeted low-cost interventions improved documentation of key aspects of intravenous fluid monitoring. Closed-loop auditing remains an effective method for improving adherence to national standards and supporting safer post-operative care.
Authors
Manas Atre, Juan Loque Solano, Ludmila Joaquim Branda, Mayank Bhandari
Wye Valley NHS Trust, Hereford, United Kingdom