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NICE issues IV guidance in bid to improve drip safety

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Nurses and other clinicians need better education to stop errors in drip fluid care and prevent potential patient harm, according to the National Institute for Health and Care Excellence.

In latest guidance NICE warned that as many as one in five patients on IV fluids and electrolytes suffer complications or even die due to their inappropriate administration.

It said a lack of formal training was a “major concern” that was putting lives at risk. It is calling on nurses and doctors in England and Wales to become better educated in how to safely care for patients given IV fluid therapy.

NICE has today recommended measures to improve education and training, including practical steps to make decision-making clearer, simpler and safer.

The guideline highlights that IV fluid therapy should always be given as part of a protocol and includes a one-page, step-by-step guide on assessing whether patients need a drip and if they do, what fluids should be given and how long for.

It represents the first time NICE has produced practical tools within one of its guidelines.

Katie Scales, consultant nurse for critical care at Imperial College Healthcare Trust and a member of the NICE guideline development group, described the guidance as an “important lever for improvement” that may “ultimately help to save lives”.

She said: “The majority of patients who receive intravenous fluids do so without complications but this is not the case for every patient.

“The guidance will help doctors and nurses to make decisions about when to give IV fluids, which fluids to choose and when to stop,” she said. “It will promote consistent assessment, decision-making and monitoring of IV fluids.”

Other key recommendations in the guidance include calling on clinicians prescribing IV fluids to remember the new “five Rs” of intravenous fluid management – resuscitation, routine maintenance, replacement, redistribution and reassessment.

In addition, NICE wants hospitals to identify an IV fluids “champion” to take the lead on ensuring best practice, with responsibility for training and auditing IV fluid prescribing and outcomes.

Patients should also have an IV fluid management plan, including details of their fluid and electrolyte prescription over the next 24 hours, the guidance added.

Clear incidents of fluid mismanagement – for example, unnecessarily prolonged dehydration or inadvertent fluid overload – should be reported through standard critical incident reporting to encourage improved training and practice, it stated.

The new guideline also makes a clear recommendation that tetrastarches should not be used for fluid resuscitation.

Earlier this year, the Medicines and Healthcare products Regulatory Agency suspended the licences for hydroxyethyl starch products, after trials showed the risks of giving these products to some patients outweighed the benefits.

Professor Mark Baker, director of NICE’s centre for clinical practice, said: “This new guideline will go a long way in helping to support healthcare professionals to provide the best level of care.”

As well as this guidance, NICE said it was working with relevant organisations to develop an online learning tool so all clinicians received formal training and education on this topic.


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