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Redesigned intravenous fluid order form with more perceived safety and accuracy for after-hours doctors​
  1. Christene Mikhail1,2,
  2. Jeffrey Ha1,3,
  3. Shraddha Banthia1,
  4. Ivan Liu1,
  5. Elizabeth Tenney1,
  6. Daniel Tardo1,
  7. George Rubin4,
  8. Justine Harris1,2
  1. 1Department of Medicine, St George Hospital, Kogarah, Sydney, New South Wales, Australia
  2. 2Department of Surgery, The Sutherland Hospital, Caringbah, Sydney, New South Wales, Australia
  3. 3Department of Medicine, St George and Sutherland Clinical School, University of New South Wales, Sydney, New South Wales, Australia
  4. 4School of Public Health, University of Sydney, Sydney, New South Wales, Australia
  1. Correspondence to Christene Mikhail; Christene.Mikhail{at}health.nsw.gov.au

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Introduction

Intravenous fluid (IVF) is often prescribed by doctors of the treating teams during daytime hours for various indications. At present, the New South Wales (NSW) IVF order form1 (online supplementary figure 1) does not include explicit documentation of the indication for prescribing IVF. As a result, the after-hours doctor is often requested to chart further IVF without knowledge of the patient’s condition or the indication for IVF.

Supplemental material

[bmjoq-2018-000379supp001.pdf]

As many as one in five patients suffer complications from inappropriate IVF prescribing.2 Patients with heart failure or liver cirrhosis are more vulnerable to fluid overload with excessive IVF therapy.3 4 Conversely, acute kidney injury is a complication of inadequate IVF prescribing.3 Other adverse effects include electrolyte imbalances potentiating the risk of life-threatening arrhythmias.5 The time constraints during a busy after-hours shift can further compromise the accuracy and safety of charting IVF for unfamiliar patients.

To overcome these barriers, we developed a revised IVF order form (online supplementary figure 2) which clearly documents the indication for IVF, the fluid restriction status and comorbidities of the patient. These simple yet critical additions will enable the IVF order form to be a useful tool in the handover of a ‘fluid plan’ for patients, between the daytime medical teams and after-hours medical and nursing staff. It will aim to assist the after-hours doctor in the safety and accuracy of prescribing IVF.

Methods

The original IVF order form1 was redesigned to include relevant patient information for safe prescribing of IVF. This included the following new sections: indication for IVF, fluid restriction status and tick boxes for relevant patient comorbidities, including diabetes, heart, liver and renal failure (online supplementary figure 2). Approval to trial the revised form (deemed very low risk in causing any patient harm) was gained from the NSW State Forms …

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