Quality standard
Quality statement 4: Identifying and reporting consequences of fluid mismanagement
Quality statement 4: Identifying and reporting consequences of fluid mismanagement
Quality statement
For adults who receive intravenous (IV) fluid therapy in hospital, clear incidents of fluid mismanagement are reported as critical incidents.
Rationale
There are a number of potential adverse consequences of IV fluid therapy, including unnecessarily prolonged dehydration, over hydration or significant electrolyte imbalance, which may be identified by clinical and biochemical monitoring. Not all adverse consequences of IV fluid therapy are due to fluid mismanagement, but clinically significant problems caused by IV fluid mismanagement should be 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.
Quality measures
The following measures can be used to assess the quality of care or service provision specified in the statement. They are examples of how the statement can be measured, and can be adapted and used flexibly.
Structure
Evidence of local arrangements to ensure that clear incidents of fluid mismanagement are reported as critical incidents for adults receiving IV fluid therapy in hospital.
Data source: Local data collection.
Process
Proportion of clear incidents of fluid mismanagement recorded for adults receiving IV fluid therapy in hospital that are reported as critical incidents.
Numerator – the number of clear incidents of fluid mismanagement in the denominator for which a critical incident is reported.
Denominator – the number of clear incidents of fluid mismanagement recorded for adults receiving IV fluid therapy in hospital.
Data source: Local data collection.
What the quality statement means for different audiences
Service providers (such as district general hospitals and specialist care centres) ensure that systems are in place for reporting clear incidents of fluid mismanagement as critical incidents.
Healthcare professionals who care for adults receiving IV fluid therapy in hospital should assess patients' responses to IV fluid therapy and report clear incidents of fluid mismanagement as critical incidents.
Commissioners ensure that they commission services for adults receiving IV fluid therapy in hospital from providers that report clear incidents of fluid mismanagement as critical incidents. This can be achieved by ensuring that providers share lessons learned from critical incident investigations.
Adults receiving IV fluid therapy in hospital are cared for in a hospital that has systems set in place so that IV fluid therapy problems (for example, patients not getting enough IV fluid and becoming severely dehydrated) are reported and dealt with correctly.
Source guidance
Intravenous fluid therapy in adults in hospital. NICE guideline CG174 (2013, updated 2017), recommendations 1.2.6 (key priorities for implementation)
Definitions of terms used in this quality statement
Clear incidents of fluid mismanagement
The identification and reporting of incidents of fluid mismanagement should be good practice. It is better to identify and report such incidents than not to identify them, or not to report them if they are identified. Therefore, implementing the quality standard may see an initial increase in incident reporting, reflecting improved identification and reporting rather than worse practice.
Recommendation 1.2.6 (key priority for implementation) in NICE's guideline on intravenous fluid therapy in adults in hospital provides the following framework for identifying and reporting adverse consequences in the context of IV fluid management based on Guideline Development Group consensus:
Consequence of fluid mismanagement | Identifying features | Time frame of identification |
---|---|---|
Hypovolaemia |
Patient's fluid needs not met by oral, enteral or IV intake and
|
Before and during IV fluid therapy |
Pulmonary oedema (breathlessness during infusion) |
|
During IV fluid therapy or within 6 hours of stopping IV fluids |
Hyponatraemia |
|
During IV fluid therapy or within 24 hours of stopping IV fluids |
Hypernatraemia |
|
During IV fluid therapy or within 24 hours of stopping IV fluids |
Peripheral oedema |
|
During IV fluid therapy or within 24 hours of stopping IV fluids |
Hyperkalaemia |
|
During IV fluid therapy or within 24 hours of stopping IV fluids |
Hypokalaemia |
|
During IV fluid therapy or within 24 hours of stopping IV fluids |