A Quality Improvement Project on Optimising Intravenous Maintenance Fluid Prescribing in Surgical Patients

TL;DR

This study shows how changing IV fluid prescriptions in surgery patients improved safety and followed national guidelines better after interventions.

Contribution

A multidisciplinary intervention using PDSA cycles significantly improved adherence to NICE IV fluid guidelines in surgical patients.

Findings

Pre-intervention, only 9.5% of IV fluid prescriptions met NICE guidelines.

Post-intervention, appropriate prescribing increased to 45% with reduced electrolyte excess.

Sustained improvement requires trust-wide policy and education.

Abstract

Background: Inappropriate intravenous (IV) fluid prescribing is a common and preventable source of morbidity in hospitalised patients. Maintenance fluids should meet daily physiological requirements without causing electrolyte imbalances or fluid overload. National Institute for Health and Care Excellence (NICE) guidelines recommend hypotonic, balanced solutions tailored to patient weight.

Aim: This study aims to evaluate adherence to NICE IV fluid prescribing guidelines in a district general hospital's general surgery department, implement targeted interventions, and assess impact through re-audit.

Methods: A three-phase quality improvement project using the Plan-Do-Study-Act (PDSA) cycle was conducted. Phase 1 involved retrospective analysis of IV maintenance fluid prescriptions for emergency laparotomy patients (n = 21). Phase 2 introduced a new default fluid (0.45% NaCl + 0.15% KCl + 5% dextrose), delivered teaching sessions, and disseminated prescribing guidance. Phase 3 was a re-audit (n = 20) conducted one month post-intervention.

Results: Pre-intervention, only 9.5% of patients received fluids in line with NICE guidance. Sodium and chloride intake exceeded recommended levels by over 200%, while potassium provision was 83% below target. Post-intervention, appropriate prescribing increased to 45%, with reductions in sodium (by 165%) and chloride (by 128%) administration, and improved potassium and dextrose provision.

Conclusion: A multidisciplinary intervention significantly improved adherence to fluid prescribing guidelines, reduced electrolyte excess, and enhanced patient safety. Sustained improvement requires trust-wide policy development, consistent education, and broader implementation across departments.

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