The National Institute for Health and Care Excellence (NICE) is calling on doctors and nurses across England and Wales to become better educated in how to safely care for patients who are given fluids through a drip (intravenous fluid therapy). Although thousands of people are likely to need a drip in hospital, NICE says there is a lack of formal training, which is putting patients' lives at risk.
Experts agree this is a major concern - if a person receives too much or too little, or the wrong type of fluid, they could develop potentially life threatening complications. Intravenous (IV) fluids are given to patients to prevent or correct problems associated with having too much or too little fluid and/or electrolytes in their bodies and it is thought that as many as 1 in 5 patients on IV fluids and electrolytes suffer complications due to their inappropriate administration, with deaths in some cases. In new guidance, NICE recommends measures to improve education and training, including practical steps to make decision-making clearer, simpler and above all, safer.
Dr Mike Stroud, consultant in gastroenterology & general (internal) medicine at Southampton University Hospitals NHS Trust, was Chair of the Guideline Development Group (GDG) which developed the recommendations on behalf of NICE. He said: "It is generally recognised throughout the NHS that little formal training relating to intravenous fluid therapy exists for healthcare professionals and this is true for both students and for professionals who are more established in their careers. This needs to change since prescribing, administering and monitoring intravenous fluids correctly is a basic aspect of care. This new NICE guideline has training and education at its heart and will play a vital role in making sure that staff at all levels in the NHS deliver consistent, high-quality care for all patients."
In addition to training and education, the guideline advocates that intravenous fluid therapy should always be given as part of a protocol and includes a one-page step-by-step guide to support healthcare professionals in assessing whether patients need a drip and if they do, what fluids should be given and how long for. This is the first time NICE has produced practical tools within its guideline.
Important recommendations include:
- Any healthcare professional prescribing IV fluids should remember the new 'five Rs' of intravenous fluid management: Resuscitation, Routine maintenance, Replacement, Redistribution and Reassessment.
- Hospitals should identify an IV fluids champion to take the lead on ensuring best IV fluid practice. They will be responsible for training, clinical governance and the auditing of IV fluid prescribing and patient outcomes.
- Patients should have an IV fluid management plan, which should include details of their fluid and electrolyte prescription over the next 24 hours as part of an ongoing reassessment and monitoring plan.
- Clear incidents of fluid mismanagement (for example, unnecessarily prolonged dehydration or inadvertent fluid overload due to IV fluid therapy) should be reported through standard critical incident reporting to encourage improved training and practice.
The new guideline also makes a clear recommendation that tetrastarches (a type of starch-based IV fluid) should not be used for fluid resuscitation. Earlier this year, the Medicines and Healthcare Products Regulatory Agency (MHRA) suspended the licences for hydroxyethyl starch products after some large randomised control trials showed that the risks of giving these products to some patients outweighed the benefits.
This guideline is now available to view on the NICE website. http://www.nice.org.uk
