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NICE issues draft standards on improving IV drip safety

Nurses are being asked for their views on new draft standards to prevent potentially life-threatening mistakes in the use of intravenous drips.

The standards were launched today by the National Institute for Health and Care Excellence, which highlighted an urgent need to tackle errors in IV fluid therapy for adults.

Research suggests as many as one in five hospital patients on drips suffer complications and may even die because drips have been administered incorrectly.

“IV fluids aren’t always prescribed or administered correctly”

Gillian Leng

NICE deputy chief executive Professor Gillian Leng said: “Intravenous fluid therapy is one of the most common hospital treatments. Unfortunately, IV fluids aren’t always prescribed or administered correctly and this can be dangerous to patients.”

The four draft standards, which accompany NICE guidance published in December last year, pinpoint areas where the institute thinks improvements are most needed.

Gillian Leng

Under the proposed standards, all hospitals must have an IV fluids lead who is responsible for training staff and reviewing the use of drips.

All healthcare professionals who administer drips must have been assessed to show they are competent in assessing patients’ fluid and electrolyte needs, prescribing and administering IV fluids and monitoring patients’ response.

Meanwhile, all adults on drips must have an IV fluid management plan and any “clinically significant” problems caused by fluid mismanagement should be routinely reported as critical incidents.

“By routinely reporting these events, even when they are well-managed, hospitals will increase learning, improving the likelihood of better patient outcomes in relation to mortality, morbidity, general discomfort and lengths of stay in hospital,” stated the draft document published by NICE.

Nurses and others have until 22 April to comment on the proposals. The final standards are expected to be published in August.

Readers' comments (9)

  • I've previously worked with a newly-qualified degree nurse who didn't even know you had to 'run the drip through' before attaching it to the patient. How can someone complete a three year course and not have ever set up a drip?

    I'll tell you how: despite what those who occupy the upper echelons of nurse education will tell you, nursing isn't all about collaborative working and completing group essays - unfortunately [for them] nursing is a practical/technical occupation and those who complete the course need at least some basic practical skills/competences on qualifying.

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  • It is a shame that you base your comments on the claim by 1 student nurse that a very small part of IV therapy has not being taught to all student nurses. I am sure you are aware that 50% of the student nurses' time is spent in clinical practice learning 'practical skill'. You have, in fact, critisied all your practice colleagues in this comment, rather than the upper echelons!

    Stop blaming university for the failings in nursing and support our student nurses.

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  • unfortunately once again the training for the equipment that the drip is delivered through is ignored. if staff aren't trained properly on the device eg volumetric infusion pumps, how can we ensure a safe delivery of the fluids?

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  • I completed 3 years "nurse training" as a mature student in 2000 and I and my fellow students received the wisdom of "practice" having become a dirty word following the wholesale destruction of the modular practice system (which had evolved over the previous 100 years). "Observation" was King at the time

    There was nothing I could do about the lack of practice. There was no Clinical Teacher to help students any more. Those who taught you theory in the classroom were working for a different organisation from those who were supposed to teach practice in the clinical setting.

    I think I ran an IV line once in 3 years.

    The shameful and farcial thing was I qualified because I passed all my exams.

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  • Anonymous | 23-Mar-2014 7:22 pm

    What, are you for real? That 'very small part of IV therapy' - as you termed it - could have resulted in the death of that patient due to air embolus: I actually had to physically intervene to stop her from attaching the drip to the patient! This wasn't a student, this was a newly qualified nurse.

    It shouldn't be left up to practice placements to teach the fundamentals, these should be taught and properly assessed at university.

    Im sure you wouldn't be so 'charitable' if it were your mother who had been put in harms way as a result of sheer incompetence!

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  • I was discussing nurses practical competencies with an old colleague of mine quite recently. We were clinical nurse teachers together.

    We both agreed that there was an urgent need to re-introduce this discipline.

    Nurses are now well educated academically but far too many lack the necessary practical skills that are fundamental to nursing. Unfortunately, this has produced some very dangerous nurses, who put patients at risk.

    I fail to understand why a degree in nursing is awarded to any individual, when they have not demonstrated a competence in all documented practical skills. Surely this should form a very important part of the degree course.

    If I returned to the wards now, I am afraid I would be "referring" an awful lot of nurses, who would then ultimately "fail" their degree.

    One final point...I see a "drip" as an idiot. Can we please have some professionalism here, it is an intravenous infusion!

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  • why are you blaming the 'degree' when 50% of the course is in practice? I can name 2 placements where there was no hands on practice and my mentors were neither present or concerned with my learning. In fact, I doubt their competence as they avoided teaching at all. You cannot blame classroom based studies for lack of practical knowledge amongst new nurses

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  • judith willis | 25-Mar-2014 2:18 am

    professionalism at all times (but not without humour). what about the time when I collected a patient from theatres and had to hold up the bag of iv fluid as there was no stand available.

    the surgeon very graciously said i looked like the 'lady with the lamp', and just plumping up my feathers with pride, the porter retorted 'lady with the drip, you mean', at which the patient in his turn whom we thought still fast asleep, suddenly sat bolt upright on his trolley and violently protested 'I beg your pardon'! :-)

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  • Valid point. Unfortunately our new degree nurses are lacking in various practical skills. The Bma though have recently reported that patient outcome and care is increased with degree status! Nothing tallies. It's about time the Nurse Educators along with practising Nurses seriously evaluate the situation. No politics....lets put the patients first. Lets have the real facts.

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