Quality statement 2: Healthcare professionals' competencies in hospitals

Quality statement

Adults receiving intravenous (IV) fluid therapy in hospital are cared for by healthcare professionals competent in assessing patients' fluid and electrolyte needs, prescribing and administering IV fluids, and monitoring patient response.

Rationale

Fluid assessment, prescription and administration are essential daily tasks in many hospital departments. These are complex responsibilities that entail careful clinical and biochemical assessment, good understanding of the principles of fluid physiology in health and disease, and appropriate supervision and training. Inadequate knowledge, failure to recognise the importance of fluid management in patient care and acting on this issue are major factors in poor fluid management, and poor education, training and supervision are major contributors. Different healthcare professionals will have different skills and competencies, relevant to their roles.

Quality measures

Structure

Evidence of local arrangements to ensure that adults receiving IV fluid therapy in hospital are cared for by healthcare professionals who are competent in assessing patients' fluid and electrolyte needs, prescribing and administering IV fluids, and monitoring patient response.

Data source: Local data collection.

Process

a) Proportion of healthcare professionals who are responsible for prescribing IV fluid therapy in hospital who are able to demonstrate competency in prescribing IV fluids.

Numerator – the number of healthcare professionals in the denominator who are able to demonstrate competency in prescribing IV fluids.

Denominator – the number of healthcare professionals who are responsible for prescribing IV fluid therapy in hospital.

Data source: Local data collection.

b) Proportion of healthcare professionals who are responsible for administering IV fluid therapy in hospital who are able to demonstrate competency in administering IV fluids.

Numerator – the number of healthcare professionals in the denominator who are able to demonstrate competency in administering IV fluids.

Denominator – the number of healthcare professionals who are responsible for administering IV fluid therapy in hospital.

Data source: Local data collection.

c) Proportion of healthcare professionals who are caring for adults on IV fluid therapy who are able to demonstrate competency in monitoring patient response.

Numerator – the number of healthcare professionals in the denominator who are able to demonstrate competency in monitoring patient response.

Denominator – the number of healthcare professionals who are monitoring adults on IV fluid therapy.

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

Service providers (such as district general hospitals and specialist care centres) ensure that systems are in place to ensure that adults receiving IV fluid therapy in hospital are cared for by a team of healthcare professionals competent in assessing patients' fluid and electrolyte needs, prescribing and administering IV fluids, and monitoring patient response.

Healthcare professionals involved in prescribing and delivering IV fluid therapy can demonstrate competence in assessing patients' fluid and electrolyte needs, prescribing and administering IV fluids, and monitoring patient response. Different healthcare professionals will have different skills and competencies, relevant to their roles.

Commissioners (clinical commissioning groups and NHS England area teams) ensure that they commission services from hospitals that are able to demonstrate that relevant healthcare professionals are competent in assessing patients' fluid and electrolyte needs, prescribing and administering IV fluids, and monitoring patient response. This can be achieved by requiring providers to supply training numbers for staff who have been trained and staff who have been assessed.

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

Adults receiving IV fluid therapy in hospital are cared for by a team of healthcare professionals who have the knowledge and skills to ensure that they receive safe and effective IV fluid therapy.

Source guidance

Definitions of terms used in this quality statement

Competencies of a team of healthcare professionals

Hospitals should establish systems to ensure that all healthcare professionals involved in prescribing and delivering IV fluid therapy are trained on intravenous therapy principles covered in NICE clinical guideline 174, and are then formally assessed and reassessed at regular intervals to demonstrate competence in:

  • understanding the physiology of fluid and electrolyte balance in patients with normal physiology and during illness

  • assessing patients' fluid and electrolyte needs (the 5 Rs: Resuscitation, Routine maintenance, Replacement, Redistribution and Reassessment)

  • assessing the risks, benefits and harms of IV fluids

  • prescribing and administering IV fluids

  • monitoring the patient response

  • evaluating and documenting changes and

  • taking appropriate action as required.

Competency needs to be tailored to the professional role, and may vary according to professional roles. For example, competency for senior clinicians will include active involvement in reviewing patients' fluid management plans, providing leadership to the junior team to ensure quality care.

Competency, in the context of this quality statement, includes IV fluid competencies relevant to people who are having total parenteral nutrition (TPN) but not competencies relating to the nutritional element of prescribing.

[Adapted from NICE clinical guideline 174, recommendation 1.6.1]