1046 IV Maintenance Fluids Prescribing in General Surgery Patients

Aim Identify if DPOW general surgery team is meeting NICE guidelines for IV fluids prescribing and offer solution for quality improvement. Method NICE guidelines 2013 states that patients should receive 25-30ml/kg/day of water and 1mmol/kg/day of sodium, potassium, and chloride with regards to maintenance fluid therapy. We conducted a retrospective audit on surgical patients. Post-operative emergency laparotomy patients were chosen randomly from surgical inpatient wards in DPOW hospital over the course of one month. Maintenance IV fluids prescribed over 24 hours were collected, adjusted according to the patients’ weight, with the exclusion of individuals with AKI and heart failure. Microsoft excel was used to calculate the average weight, fluid volume and electrolyte administration. Results Over the specified time frame, 21 patients were identified. The mean weight among these patients was 72kg. The typical daily intake of total fluid volume amounted to 2.5L. During the 24-hour post-operative period, the mean electrolyte concentration administered were as follows: 249mmol Sodium, 12mmol potassium, 228mmol chloride. Taking into account the average patient weight, there is a net administration of +177mmol sodium, -60mmol potassium, +156mmol chloride. Conclusions The electrolytes administered were inappropriate with too much sodium, chloride and too little potassium. Patients on average received 246% excess sodium, 83% less potassium and 217% chloride than the recommended daily requirement. Interventions including teaching sessions and posters to foundation doctors to improve the appropriateness of intravenous maintenance fluids prescription in the hospital has been done. The next data collection after intervention will be done by the end of December 2024.