Quality statement 2: Assessment of fluid balance

Quality statement

Term neonates, children and young people receiving intravenous (IV) fluid therapy have their fluid balance assessed when starting IV fluids and then at least every 12 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, assessing and documenting patients' fluid balance, initially and then every 12 hours, ensures that the correct amount 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 fluid balance assessed when starting IV fluids and then at least every 12 hours.

Data source: Local data collection.

Process

a) Proportion of term neonates, children and young people starting IV fluid therapy who have their fluid balance assessed.

Numerator – the number in the denominator who have their fluid balance assessed.

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 fluid balance assessed every 12 hours or less from starting IV fluids.

Numerator – the number in the denominator who have their fluid balance assessed every 12 hours or less from starting 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 fluid balance assessed and documented when starting IV fluids and then at least every 12 hours.

Healthcare professionals (such as hospital doctors and nurse practitioners) ensure that term neonates, children and young people have their fluid balance assessed and documented when they start IV fluids and then at least every 12 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 fluid balance assessed and documented when starting IV fluids and then at least every 12 hours. A standardised fluid balance chart should be agreed to help staff assess patients' fluid needs, 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 their fluid levels checked when they start IV fluid therapy to decide the amount of IV fluid they need, and then at least every 12 hours to ensure that they continue to receive the right amount of IV fluid. 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