Clinical guidelines on drugs and prescribing

Intravenous fluid therapy in adults in hospital

The National Institute for Health and Care Excellence (NICE) has published a quality standard Intravenous fluid therapy in adults in hospital, which covers the assessment and management of adults' intravenous (IV) fluid needs in hospital. IV fluid therapy is the provision of fluid and/or electrolytes directly into the vein. This quality standard does not cover the use of blood or blood products. 

Why this quality standard is needed

Many adult hospital inpatients need IV fluid therapy to prevent or correct problems with their fluid and/or electrolyte status. This may be because their normal needs cannot be met through enteral routes (for example, they have swallowing problems or gastrointestinal dysfunction) or because they have unusual fluid and/or electrolyte deficits or demands caused by illness or injury (for example, high gastrointestinal or renal losses). Deciding on the optimal amount and composition of IV fluids to be administered and the best rate at which to give them can be a difficult task, and decisions must be based on careful assessment of the patient's individual needs.

Management

Errors in prescribing IV fluids and electrolytes are particularly likely in emergency departments, acute admission units, and general medical and surgical wards rather than in operating theatres and critical care units. Surveys have shown that many staff who prescribe IV fluids know neither the likely fluid and electrolyte needs of individual patients, nor the specific composition of the many choices of IV fluids available to them. Standards of recording and monitoring IV fluid and electrolyte therapy may also be poor in these settings. IV fluid management in hospital is often delegated to the most junior medical staff who frequently lack the relevant experience and may have received little or no specific training on the subject.

The National Confidential Enquiry into Perioperative Deaths report in 1999 highlighted that a significant number of hospitalised patients were dying as a result of infusion of too much or too little fluid. The report recommended that fluid prescribing should be given the same status as drug prescribing. Although mismanagement of fluid therapy is rarely reported as being responsible for patient harm, it is likely that as many as 1 in 5 patients on IV fluids and electrolytes suffer complications or morbidity due to their inappropriate administration.

The quality standard is expected to contribute to improvements in the following outcomes:

• Mortality or serious harm resulting from errors in IV fluid therapy.
• Patient experience of hospital care.
• Patient safety incidents reported.
• Length of hospital stay.

Managing medicines in care homes

This guideline covers good practice for managing medicines in care homes. It aims to promote the safe and effective use of medicines in care homes by advising on processes for prescribing, handling and administering medicines, and includes an interactive flowchart. It also recommends how care and services relating to medicines should be provided to people living in care homes.

Medicines optimisation guideline

NICE Medicines and Prescribing Centre has published its Medicines optimisation clinical guideline (March 2015) to provide guidance on the safe and effective use of medicines to enable the best possible outcomes. The report looks at cost effectiveness, systems for identifying medicines-related safety incidents, communication systems and medication review.