Background and importance Intravenous fluid stewardship can support caregivers to optimise the patient’s outcome, avoid fluid overload or electrolyte disorders, and control costs. Implementing a stewardship initiative requires monitoring to guarantee guideline adherence.
Aim and objectives To evaluate the impact of an internal audit on intravenous fluid use and identify opportunities to improve quality monitoring.
Material and methods To evaluate fluid guideline adherence in a Belgian university hospital, an internal audit was organised comprising five QIs, developed by the fluid stewardship programme. The QIs were calculated every 2 weeks over a 6 month period (August 2019 to January 2020), focusing on prescription and labelling, documentation of indication and monitoring of body weight and electrolytes. Every ward steward (22 physicians, 16 nurses) received the results of the first 3 months (T1) in an electronic report. The report’s impact on the QIs between T1 and the following 3 months (T2) was assessed using a χ2 test and interrupted time series (ITS) analysis. Afterwards, stewards were surveyed on how to further optimise fluid management monitoring.
Results In total, 729 patients (T1: 361; T2: 368) receiving 758 intravenous fluid bags (T1: 381; T2: 377) were screened. QIs on prescription and labelling were close to the target value. The QI ‘documented indication’ was low (21%). ‘Availability of electrolyte values’ increased significantly between T1 and T2 (90.3% vs 96.2%, p<0.05). ITS analysis could not definitely attribute this effect to our intervention. Internal medicine wards had significantly better results for the ‘availability of electrolyte values’ QI compared with surgical wards (T1: 95.3% vs 77.8%, p<0.05; T2: 98.4% vs 91.3%, p<0.05). The QI ‘documented body weight’ showed similar findings (T1: 82.1% vs 62.5%, p<0.05; T2: 80.2% vs 66.3%, p<0.05). The survey (32% response rate) showed that the feedback report had an appropriate format and length (median scores 3/5), although only 33% of the stewards had disseminated the results to colleagues.
Conclusion and relevance Awareness of electrolyte disorders increased among physicians, but the direct impact of our feedback remains unclear. Other QIs showed little room for improvement and need re-evaluation. Overall results suggested a persistent need for training on intravenous fluids, especially on surgery wards, and feedback should include tailored communication with staff.
Conflict of interest No conflict of interest
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