467 Fluid Balance Documentation and Fluid Prescribing in Surgical Patients at a District General Hospital: Are Posters Too Passive for an Effect?

Aim

t is estimated that 1-in-5 patients receiving intravenous (IV) fluid therapy suffer from complications following inappropriate fluid prescribing. In March 2022, a spot audit evaluating fluid management in 20 surgical patients highlighted inaccuracies in fluid balance documentation, with up to 70% of sampled patients in an excess fluid balance.

As interventions, educational posters and teaching on IV fluids were delivered to doctors and nurses. A second audit cycle was sought to re-assess the impact of the interventions.

Method

A 30-item proforma was used to audit 100 general surgical patients between May-June 2022. Parameters collected included reasons for IV fluids and renal function. To assess doctors’ satisfaction with the intervention, an online survey was distributed among doctors working in General Surgery. All data were analysed using statistical software (SPSS).

Results

Half of the sampled patients were on IV fluids. Only 50% had an indication documented, and 56% had IV fluids in their management plan. 37% were in fluid excess. Accurate urine and stool measurements were recorded in 68% and 75% of patients, respectively. Drains and stomas were higher (relative to the first cycle). All doctors felt the posters were beneficial; only 36% of doctors felt comfortable with fluid prescribing before the posters, which increased to 93% after the posters were distributed.

Conclusions

Fluid management remains a cornerstone of surgical care. Fluid status should be incorporated into the daily patient assessment. Visual tools, such as posters, need objective assessment over longer durations to evaluate their benefit for healthcare professionals and patients.