Proper Intravenous fluid management can reduce mortality, morbidity and in-patient stay.
As a Foundation Doctor at the Royal Albert Edward Infirmary (part of the Wigan, Wrightington and Leigh NHS Foundation Trust) I had the fantastic opportunity to attend the BaSIS course (Building Safety Improvement Skills); a quality and safety improvement workshop aimed at empowering junior doctors to get involved with change management in their local Trusts. The course, run by the NHS Institute for Innovation and Improvement, enabled us to trial initiating our own small scale safety improvement projects with the help and mentoring of a senior staff member.
Myself and my colleague Anna Moss chose to look at improving the reliability of Intravenous fluid prescriptions on the adult medical and surgical wards. A short trial run of PDSA (Plan, Do, See, Act) cycles enabled to see the broader challenges in this area. There was little continuity or concensus on fluid prescribing methods; often important information such as fluid balance, special circumstances and electrolyte results were overlooked as the information was stored on a variety of different charts in different locations. You can watch the evolution of our project in the Building Safer Care documentary.
After presenting our work in Orlando Florida at the Institute for Helathcare Improvement Annual Forum Dec 2009, I returned to Wigan determined to continue with this work stream and established a small informal fluid management forum of like-minded colleagues.
After several months of drumming up support and drafting various documents, we developed a Fluid Management Board; a multi-disciplinary document encompassing guidance on best practice, planning and prescribing sections, regular fluid balance and electrolyte records as well as patient specific needs/special circumstances.
Currently we are seeking Trust wide approval for the document, and I must take the chance to thank Dr Martin Farrier, who has championed this project in it’s final stages and has been an inspiration for me in the art of change management!
