Introduction

This quality standard covers the management of intravenous (IV) fluids in term neonates (babies born at term or born prematurely with a corrected age of term or more), children and young people under 16 years. It covers IV fluids used for a range of conditions and in different hospital settings. It does not cover term neonates, children and young people with condition-specific IV fluid needs, because they are under the care of specialists due to their specific needs. For more information see the IV fluid therapy in children and young people in hospital topic overview.

NICE quality standard 66 for IV fluid therapy in adults in hospital covers young people and adults aged 16 and over.

Why this quality standard is needed

A correct fluid and electrolyte balance is essential to maintain normal physiological function. Term neonates, children and young people may need IV fluids for a number of reasons to maintain this balance:

  • Routine maintenance: to correct or maintain the fluid and electrolyte balance when term neonates, children and young people are not able to maintain their normal fluid needs by eating and drinking.

  • Fluid replacement: to replace red blood cells, plasma, water or electrolytes beyond the usual losses in urine, stools and sweat. These losses can come from burns, diarrhoea, vomiting or leakage of fluid into the interstitial space. In these cases, the aim is to rebalance and redistribute fluids and ensure the correct levels of electrolytes.

  • Fluid resuscitation: to rapidly expand blood volume, restore or maintain blood flow to the organs can be a lifesaving intervention. IV fluid resuscitation is commonly used in term neonates, children and young people undergoing major surgery, to treat sepsis, and after severe trauma.

When IV fluid therapy is needed for routine maintenance, fluid replacement or fluid resuscitation, it is vital that the correct composition, volume and timing of IV fluid therapy are used. Different types of IV fluids are appropriate for different situations.

Errors in prescribing or administering IV fluids can result in adverse events caused by inadequate or excessive provision. These events include abnormalities in plasma electrolytes and glucose (hyponatraemia [decreased sodium in the blood; defined as plasma sodium less than 135 mmol/litre] and hypernatraemia [increased sodium in the blood; defined as plasma sodium greater than 145 mmol/litre]) and clinical consequences such as hypovolaemia (decreased blood volume) and poor organ perfusion (lack of blood circulating through the organs), hypervolaemia (increased blood volume), cerebral oedema (brain swelling) and heart failure. Failure to correct imbalances and deliver correct fluids can have a significant impact on morbidity and mortality.

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

  • patient safety incidents resulting from errors in IV fluid therapy

  • length of hospital stay

  • children's and young peoples' experience of inpatient services

  • mortality resulting from errors in IV fluid therapy.

How this quality standard supports delivery of outcome frameworks

NICE quality standards are a concise set of prioritised statements designed to drive measurable improvements in the 3 dimensions of quality – safety, experience and effectiveness of care – for a particular area of health or care. They are derived from high-quality guidance, such as that from NICE or other sources accredited by NICE. This quality standard, in conjunction with the guidance on which it is based, should contribute to the improvements outlined in the following 2 outcome frameworks published by the Department of Health:

Tables 1 and 2 show the outcomes, overarching indicators and improvement areas from the frameworks that the quality standard could contribute to achieving.

Table 1 NHS outcomes framework 2016–17

Domain

Overarching indicators and improvement areas

1 Preventing people from dying prematurely

Overarching indicators

1a Potential Years of Life Lost (PYLL) from causes considered amenable to healthcare

ii Children and young people

1c Neonatal mortality and stillbirths

Improvement areas

Reducing mortality in children

1.6 i Infant mortality*

4 Ensuring that people have a positive experience of care

Overarching indicators

4b Patient experience of hospital care

Improvement areas

Improving children and young people's experience of healthcare

4.8 Children and young people's experience of inpatient services

5 Treating and caring for people in a safe environment and protecting them from avoidable harm

Overarching indicators

5a Deaths attributable to problems in healthcare

5b Severe harm attributable to problems in healthcare

Improvement areas

Improving the culture of safety reporting

5.6 Patient safety incidents reported

Alignment with Public health outcomes framework

* Indicator is shared

Indicators in italics in development

Table 2 Public health outcomes framework for England 2016–19

Domain

Objectives and indicators

4 Healthcare public health and preventing premature mortality

Objective

Reduced numbers of people living with preventable ill health and people dying prematurely, whilst reducing the gap between communities

Indicators

4.01 Infant mortality*

4.03 Mortality rate from causes considered preventable**

Alignment with NHS outcomes framework

* Indicator is shared

** Indicator is complementary

Safety and people's experience of care

Ensuring that care is safe and that people have a positive experience of care is vital in a high-quality service. It is important to consider these factors when planning and delivering services relevant to IV fluid therapy in term neonates, children and young people in hospital.

Coordinated services

The quality standard for IV fluid therapy in term neonates, children and young people in hospital specifies that services should be commissioned from and coordinated across all relevant agencies encompassing the whole care pathway. A person-centred, integrated approach to providing services is fundamental to delivering high-quality care to term neonates, children and young people receiving IV fluid therapy.

The Health and Social Care Act 2012 sets out a clear expectation that the care system should consider NICE quality standards in planning and delivering services, as part of a general duty to secure continuous improvement in quality. Commissioners and providers of health and social care should refer to the library of NICE quality standards when designing high-quality services. Other quality standards that should also be considered when choosing, commissioning or providing a high-quality service for IV fluid therapy in term neonates, children and young people in hospital are listed in related NICE quality standards.

Training and competencies

The quality standard should be read in the context of national and local guidelines on training and competencies. All healthcare professionals involved in assessing, caring for and treating term neonates, children and young people receiving IV fluid therapy should have sufficient and appropriate training and competencies to deliver the actions and interventions described in the quality standard. Quality statements on staff training and competency are not usually included in quality standards. However, recommendations in the development source on specific types of training for the topic that exceed standard professional training are considered during quality statement development.

Role of families and carers

Quality standards recognise the important role families and carers have in supporting term neonates, children and young people receiving IV fluid therapy. If appropriate, healthcare professionals should ensure that family members and carers are involved in the decision-making process about investigations, treatment and care.