Quality standard
Quality statement 1: Intravenous fluids lead
Quality statement 1: Intravenous fluids lead
Quality statement
Hospitals have an intravenous (IV) fluids lead who has overall responsibility for training, clinical governance, audit and review of IV fluid prescribing, and patient outcomes.
Rationale
The IV fluids lead in a hospital can promote best practice, ensuring that healthcare professionals are trained in prescribing and administering IV fluid therapy, and reviewing learning from 'near miss' and critical incident reporting. This leadership role can ensure continuity of care in relation to fluid management through coordination between different hospital departments.
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 that hospitals have an IV fluids lead who has overall responsibility for ensuring adequate training, clinical governance, audit and review of IV fluid prescribing, and patient outcomes.
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 they have an IV fluids lead who has overall responsibility for ensuring adequate training, clinical governance, audit and review of IV fluid prescribing, and patient outcomes.
Healthcare professionals who care for adults receiving IV fluid therapy in hospital work in the context of clinical governance arrangements that have an IV fluids lead who has overall responsibility for ensuring adequate training, clinical governance, audit and review of IV fluid prescribing, and patient outcomes.
Commissioners ensure that they commission services from hospitals that have an IV fluids lead who has overall responsibility for ensuring adequate training, clinical governance, audit and review of IV fluid prescribing, and patient outcomes.
Adults receiving IV fluid therapy are cared for in a hospital that has a person who has overall responsibility for ensuring that they receive safe and effective IV fluid therapy.
Source guidance
Intravenous fluid therapy in adults in hospital. NICE guideline CG174 (2013, updated 2017), recommendation 1.6.3 (key priority for implementation)
Definition of terms used in this quality statement
Responsible IV fluids lead
The IV fluids lead will have overall responsibility, through a leadership role, for the quality of care relating to IV fluid therapy. The IV fluids lead should be somebody in a senior position (such as the chief of medicine or the chief nurse), and may delegate specific functions through normal governance structures. The IV fluids lead is not expected to be the person who delivers the training, clinical governance, audit and review of IV fluid prescribing, and patient outcomes. Those functions can be delegated to professionals who have the necessary specialist knowledge in the hospital. [Expert opinion]
Training
Training in fluid management should also be embedded in both general and specialty training programmes, with clear curriculum-based teaching objectives and delineation of minimum standards of clinical competency and knowledge for each stage of training and clinical delivery. Recognition and management of the clinical complications of fluid management should also be considered. [NICE's guideline on intravenous fluid therapy in adults in hospital]
Training in prescribing and administering IV fluids can be supported by the online e-learning module for NICE's guideline on intravenous fluid therapy in adults in hospital. The e‑learning module uses interactive activities to support prescribers to safely assess, prescribe for and review adults needing IV fluids. The tool may also be useful for trainee prescribers to enhance their knowledge base before they start prescribing practice.