Fluid Review Tab

L Tikare and N West Problem

Fluid reviews are vital across medicine and surgery to manage admission diagnoses and prevent iatrogenic complications.1-3 Improper fluid management can result in significant morbidity or mortality, with as many as 1 in 5 on IV fluids suffering harm due to incorrect administration. 4 Responsibility to complete fluid reviews falls often on the most junior of doctors who lack experience and specific training on conducting these assessments. 4

Aim

To develop a tool which contains components recommended by NICE and our local cardiology team, to aid in the completion of a fluid review. 5

Pdsa 1

• Plan - Identify if fluid reviews are an issue for junior doctors in our trust.

• Do - Short survey to junior doctors.

• Study - 66% of doctors felt unsure when doing fluid reviews. 63% reported reviews would take >10 minutes. Elements doctors considered included weight, observations, intake/output, diuretic therapy.

• Act- A need for a standardising fluid reviews, and initial components to consider.

Pdsa 2

• Plan - Finalise elements needed for review.

• Do - Discussions with local cardiology team.

• Study - Consultants and specialist nurses agreed this would be useful in their daily practise. Additional recommended elements: Hb, ferritin, NT-pro BNP, and renal function.

• Act - Acquired content needed for tab development.

Pdsa 3

• Plan - Develop the Fluid Review Tab.

• Do - Develop prototypes and consult cardiology team for feedback.

• StudyImprovementsadding the timeline function, allowing both numerical and graphical data for clearer trends.

• Act - Tab completed and now live!

Future development

• Advertising to healthcare professionals.

• Feedback to improve further.

• Reassess junior doctor confidence.

• Timing how long reviews take with and without the tab.

• Teaching sessions for junior colleagues.

Lessons learnt

• Importance of an accurate and thorough fluid review.

• Limitations to a good fluid review.

• Understanding that our tab cannot replace a physical exam.

• Leading and developing a QI project.

• Resource development – who to contact and when.

• Teamwork and involvement of MDT.