Quality statement 1: Measuring plasma electrolyte concentration and blood glucose

Quality statement

Term neonates, children and young people receiving intravenous (IV) fluid therapy have their plasma electrolyte concentrations and blood glucose measured when starting IV fluids and then at least every 24 hours.

Rationale

Continual assessment and monitoring of IV fluid, plasma electrolyte and blood glucose needs is important to ensure term neonates, children and young people maintain a correct fluid and electrolyte balance to reduce the risk of adverse events. As part of this, measuring and documenting patients' plasma electrolyte concentrations and blood glucose, initially and then every 24 hours, ensures that the correct type (that is, concentration of sodium and glucose) of IV fluid is prescribed. Documenting this, ideally on a standardised chart, helps healthcare professionals assess patients' fluid and electrolyte needs, prescribe and administer IV fluids, and monitor patient response. It is also helpful for healthcare professionals when patients are moved between or within hospitals.

Quality measures

Structure

Evidence of local arrangements to ensure that term neonates, children and young people receiving IV fluid therapy have their plasma electrolyte concentrations and blood glucose measured when starting IV fluids and then at least every 24 hours.

Data source: Local data collection.

Process

a) Proportion of term neonates, children and young people starting IV fluid therapy who have their plasma electrolyte concentrations and blood glucose measured.

Numerator – the number in the denominator who have their plasma electrolyte concentrations and blood glucose measured.

Denominator – the number of term neonates, children and young people starting IV fluid therapy.

Data source: Local data collection.

b) Proportion of term neonates, children and young people receiving IV fluid therapy who have their plasma electrolyte concentrations and blood glucose measured every 24 hours or less from the start of IV fluids.

Numerator – the number in the denominator who have their plasma electrolyte concentrations and blood glucose measured every 24 hours or less from the start of IV fluids.

Denominator – the number of term neonates, children and young people receiving IV fluid therapy.

Data source: Local data collection.

Outcome

Patient safety incidents resulting from errors in IV fluid therapy in term neonates, children and young people.

Data source: Local data collection.

What the quality statement means for service providers, healthcare professionals and commissioners

Service providers (hospitals) ensure that systems are in place for term neonates, children and young people to have their plasma electrolyte concentrations and blood glucose status measured and documented when starting IV fluids and then at least every 24 hours.

Healthcare professionals (such as hospital doctors and nurse practitioners) ensure that they measure and document plasma electrolyte concentrations and blood glucose in term neonates, children and young people when starting IV fluids and then at least every 24 hours.

Commissioners (such as clinical commissioning groups and NHS England) ensure that they commission services in which term neonates, children and young people have their plasma electrolyte concentrations and blood glucose measured and documented when starting IV fluids and then at least every 24 hours. A standardised fluid balance chart should be agreed to help staff assess patients' plasma electrolyte and blood glucose status, prescribe and administer IV fluids, monitor patient response and help staff when patients move between hospitals and between hospital departments.

What the quality statement means for patients, service users and carers

Term neonates (babies born at full term), children and young people have blood tests when they start IV fluid therapy to decide the type of IV fluid they need, and then again at least every 24 hours to ensure that they continue to receive the right type of IV fluid. The blood tests are to find out the levels of salt and sugar in the blood. All the information is recorded on a chart in their medical notes. Intravenous fluids (usually shortened to 'IV' fluids) are liquids given to replace water, sugar and salt that a person might need if they are ill or having an operation, and can't eat or drink as they would normally. IV fluids are given straight into a vein through a drip.

Source guidance

Definitions of terms used in this quality statement

Plasma electrolyte and blood glucose status

Both sodium and glucose should be measured as part of this assessment. This assessment should not routinely take place before elective surgery unless there is a need to do so, based on the child's medical condition or type of surgery.

[NICE guideline on intravenous fluid therapy in children and young people in hospital, recommendations 1.2.4, 1.2.5 and 1.4.5]