FIGURE 6
Extract of fluid prescriptions from new ELHT prescription chart
Resuscitation fuild If more than 2 litres is administered in a single episode , contact the critical care team for advice , do not prescribe further fluids
Plasma-Lyte 148 ® 500ml or 250ml delete as appropriate |
Date |
|
|
|
|
|
Date : Give IV at 1200ml / hour until dose has been delivered
Prescribers signature
Pharmacist check
|
Time
Signature
|
Review prescriber ’ s signature |
Review prescriber ’ s signature |
Review prescriber ’ s signature |
Review prescriber ’ s signature |
Fluid replacement / routine fluid maintenance / fluid redistribution Include medicines in fluids > 100ml ( except antimicrobials )
Prescription Admistration
Infusion fluid |
Additional drug |
Route and rate |
If rate is varied from that |
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|
|
prescribed , an entry must |
|
|
|
be made in the care record |
Pharmacist check
Pharmacy supply
Name / strength |
Volume |
Medicine |
Dose |
Route IV SC Other : |
|
ml / hour or duration |
Date : |
Start time : |
Nurse 1 signature
Volume given ( ml )
|
Nurse ’ s signature |
Prescriber ’ s signature Date : Time : |
Indication : Maintenance Replacement Redistribution Other |
Nurse 2 signature |
End time : |
development phase is taking place and will launch as soon as it is registered as a medical device .
A training film has been developed , showing clinicians how to use the Blippit Meds fluid prescribing decision aid as well as the injectable monographs section . This can be seen at https :// bit . ly / BlippitMeds .
As an example , the composite screenshot in Figure 7 illustrates the routine maintenance calculator ; one of three calculators in the app . Key ‘ smart ’ features have been included to ensure that variables such as comorbidities , ongoing intravenous antibiotic volumes are included when working out dosing , and finally it shows the dose and choice of fluid based on the user ’ s total inputs .
For all three calculators , if additional fluids selected means the calculated volume is in the range 0 – 200ml , then a pop-up message appears suggesting no extra fluid is required today and to reassess the next day . If the volume of additional fluids exceeds the calculated volume , then a separate pop-up message appears warning the clinician there is a risk of fluid overload and they should consult a senior decision-maker .
Blippit Meds will be commercially available in 2021 ( blippitmeds . com ; support @ blippit . co . uk ).
What next ? Our imperative is to successfully launch the new prescription chart and the Blippit Meds app , with appropriate communications to the Trust ’ s clinicians . The pharmacists delivering our Dedicated Ward Pharmacy service will be well placed to support prescribers and nurses to utilise these two new innovations .
Ward fluid stocklists will also be reviewed again to ensure the range of fluids and volumes match changes in demand . And then , we will re-audit the fluid prescriptions to see if all the changes have improved the quality of prescribing , and take whatever action is necessary to address any concerns raised , or hopefully have a warm sense of achievement of a job well done !
Conclusions To find out what happened next , look out for Part 2 of this series ( coming soon ), and , in the meantime , perhaps consider how you could introduce a fluid stewardship programme in your organisation and become good ‘ fluid stewards ’.
References 1 International Fluid Academy 2021 . www . fluidacademy . org ( accessed Sept 2021 ). 2 Malbrain M et al . It is time for improved fluid stewardship . ICU Manage Pract 2018 ; 18 ( 3 ). https :// healthmanagement . org / c / icu / issuearticle / it-is-timefor-improved-fluid-stewardship ( accessed Sept 2021 ). 3 National Institute for Health and Care Excellence . Intravenous fluid therapy in adults in hospital . CG174 . www . nice . org . uk / guidance / cg174 ( accessed Sept 2021 ). 4 National Confidential Enquiry into Perioperative Deaths . The 2000 Report of the National Confidential Enquiry into Perioperative Deaths . www . ncepod . org . uk / 2000report3 / TaNfull . pdf ( accessed Sept 2021 ). 5 East Lancashire Hospitals NHS Trust ( 2021 ). Fluid Stewardship . https :// elht . nhs . uk / services / pharmacy / fluid-stewardship ( accessed Sept 2021 ). 6 Gray A , Wallett J , Fletcher N . Dedicated ward pharmacists make an impact . Hospital Pharmacy Europe . https :// hospitalpharmacyeurope . com / news / editors-pick / dedicatedward-pharmacists-make-animpact / ( accessed Sept 2021 ). 7 East Lancashire Hospitals ’ Pharmacy Directorate . ELHT Dedicated Ward Pharmacy : Haelo Graduation Film . https :// www . youtube . com / watch ? v = pLaMzyujh60 ( accessed Sept 2021 ). 8 Summary of Product Characteristics . Maintelyte solution for infusion . www . medicines . org . uk / emc / product / 10010 ( accessed Sept 2021 ).
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