hsc trust’s policy collaborative
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HSC Trust’s Policy Collaborative. Paediatric Fluid Prescription & Balance Chart Roll out - 2013. Aim: To instruct staff on the correct completion of the. Outcomes: Demonstrate the ability to: calculate and complete fluid prescription. correctly administer fluids. - PowerPoint PPT PresentationTRANSCRIPT
May 2013 – V0.7 Paediatric Fluid Prescription & Balance ChartHSC Trust’s Policy CollaborativeHSC Trust’s Policy CollaborativeHSC Trust’s Policy CollaborativeHSC Trust’s Policy Collaborative
May 2013 – V0.7 Paediatric Fluid Prescription & Balance Chart
Aims and outcomes of session.Aims and outcomes of session.Aims and outcomes of session.Aims and outcomes of session.
Aim: To instruct staff on the
correct completion of the
Outcomes:
Demonstrate the ability to: calculate and complete
fluid prescription. correctly administer fluids. correctly complete a fluid
balance chart.
2
paediatric fluid prescription & balance chart.
May 2013 – V0.7 Paediatric Fluid Prescription & Balance Chart
NPSA alert 22NPSA alert 22NPSA alert 22NPSA alert 22
3
May 2013 – V0.7 Paediatric Fluid Prescription & Balance Chart 4
FrontFront
May 2013 – V0.7 Paediatric Fluid Prescription & Balance Chart 5
BackBack
May 2013 – V0.7 Paediatric Fluid Prescription & Balance Chart
Chart must be used for children aged from 4 weeks up to their 16th birthday throughout each of the 5 HSC Trusts wherever their care is provided. Except for patients
cared for in ICUs, HDUs, specialist units with diabetic ketoacidosis with acute burns. who may use different fluid prescription
charts.6
May 2013 – V0.7 Paediatric Fluid Prescription & Balance Chart
1.1. Labelling Labelling1.1. Labelling Labelling
7
Stick on labels and complete hospital, ward & date on both sides of chart
FrontFront
BackBackand
May 2013 – V0.7 Paediatric Fluid Prescription & Balance Chart
2. 2. Insert patient’s weight in kgsInsert patient’s weight in kgs2. 2. Insert patient’s weight in kgsInsert patient’s weight in kgs
8
The weight used must be a recent weight
Indicate whether estimated or measured & when.
May 2013 – V0.7 Paediatric Fluid Prescription & Balance Chart
3. 3. Complete previous days fluid volumesComplete previous days fluid volumes3. 3. Complete previous days fluid volumesComplete previous days fluid volumes
9
May 2013 – V0.7 Paediatric Fluid Prescription & Balance Chart
Prescribing fluids
Administering fluids
Completing fluid balance chart
Recording intake
Recording output
Recording balance
Start next days chart
10
For information onFor information onFor information onFor information on
slide 11
slide 25slide 26slide 26slide 34slide 40slide 45
May 2013 – V0.7 Paediatric Fluid Prescription & Balance Chart 11
Method for prescribing fluids based on:-Method for prescribing fluids based on:-Method for prescribing fluids based on:-Method for prescribing fluids based on:-
May 2013 – V0.7 Paediatric Fluid Prescription & Balance Chart 12
Thus, fluid prescription based upon:-Thus, fluid prescription based upon:-Thus, fluid prescription based upon:-Thus, fluid prescription based upon:-
Shock Fluid Bolus
Maintenance
Correct deficit
Ongoing fluid losses
May 2013 – V0.7 Paediatric Fluid Prescription & Balance Chart 13
Method for prescribing fluids:-Method for prescribing fluids:-Method for prescribing fluids:-Method for prescribing fluids:-
Shock Fluid Bolus
Maintenance
Correct deficit
Ongoing fluid losses
May 2013 – V0.7 Paediatric Fluid Prescription & Balance Chart 14
Method for prescribing fluids:-Method for prescribing fluids:-Method for prescribing fluids:-Method for prescribing fluids:-
Shock Fluid Bolus
Maintenance
Correct deficit
Ongoing fluid losses
May 2013 – V0.7 Paediatric Fluid Prescription & Balance Chart 15
Method for prescribing fluids:-Method for prescribing fluids:-Method for prescribing fluids:-Method for prescribing fluids:-
Shock Fluid Bolus If fluid bolus required calculate volume prescribe record indication as
B 01/01/xxxx 500 mls12:00 0.9% Sodium Chloride
B
BB
B
May 2013 – V0.7 Paediatric Fluid Prescription & Balance Chart 16
Method for prescribing fluids:-Method for prescribing fluids:-Method for prescribing fluids:-Method for prescribing fluids:-
Shock Fluid Bolus
Maintenance Calculate maintenance requirements record indication as
M
May 2013 – V0.7 Paediatric Fluid Prescription & Balance Chart 17
Method for prescribing fluids:-Method for prescribing fluids:-Method for prescribing fluids:-Method for prescribing fluids:-
Shock Fluid Bolus
Maintenance Calculate maintenance requirements record indication as M
B 01/01/xxxx 500 mls12:00 0.9% Sodium Chloride
M 01/01/xxxx 500mls12.30 Hartmann’s Solution
M
May 2013 – V0.7 Paediatric Fluid Prescription & Balance Chart 18
Method for prescribing fluids:-Method for prescribing fluids:-Method for prescribing fluids:-Method for prescribing fluids:-
Shock Fluid Bolus
Maintenance
Correct deficit Is there a fluid deficit? calculate correction prescribe record indication as D
May 2013 – V0.7 Paediatric Fluid Prescription & Balance Chart 19
Method for prescribing fluids:-Method for prescribing fluids:-Method for prescribing fluids:-Method for prescribing fluids:-
Shock Fluid Bolus
Maintenance
Correct deficit
B 01/01/xxxx 500 mls12:00 0.9% Sodium Chloride
M 01/01/xxxx 500mls12:30 Hartmann’s Solution
D 01/01/xxxx 500mls12:30 0.9% Sodium Chloride
May 2013 – V0.7 Paediatric Fluid Prescription & Balance Chart 20
Method for prescribing fluids:-Method for prescribing fluids:-Method for prescribing fluids:-Method for prescribing fluids:-
Shock Fluid Bolus
Maintenance
Correct deficit
Ongoing fluid lossesIf there are any ongoing losses calculate prescribe record indication as O
May 2013 – V0.7 Paediatric Fluid Prescription & Balance Chart 21
Method for prescribing fluids:-Method for prescribing fluids:-Method for prescribing fluids:-Method for prescribing fluids:-
Shock Fluid Bolus
Maintenance
Correct deficit
Ongoing fluid lossesB 01/01/xxxx 500 mls12:00 0.9% Sodium Chloride
M 01/01/xxxx 500mls12:30 Hartmann’s Solution
D 01/01/xxxx 500mls12:30 0.9% Sodium Chloride
O 01/01/xxxx 500mls17:00 0.9% Sodium Chloride
May 2013 – V0.7 Paediatric Fluid Prescription & Balance Chart 22
4. 4. Prescribe fluidsPrescribe fluids4. 4. Prescribe fluidsPrescribe fluids
B 01/01/xx 500 mls12:00 0.9% Sodium Chloride Over 30 minutes Xxxx. Xxxxx
M 01/01/xx 500 mls1230 Hartmann’s Solution 65 mls/hr Xxxx. Xxxxx
O 01/01/xx 500 mls1700 0.9% Sodium Chloride 20 mls/hr Xxxx. Xxxxx10 mmol KCl
Example 1:Based on 25 kg child.Example 1:Based on 25 kg child.
May 2013 – V0.7 Paediatric Fluid Prescription & Balance Chart 23
4. 4. Prescribe fluidsPrescribe fluids4. 4. Prescribe fluidsPrescribe fluids
*
* Medicines must be recorded in Drug Kardex
B 01/01/xx 500 mls12:00 0.9% Sodium Chloride Over 30 minutes Xxxx. Xxxxx
M 01/01/xx 500 mls1230 Hartmann’s Solution 65 mls/hr Xxxx. Xxxxx
O 01/01/xx 500 mls1700 0.9% Sodium Chloride 20 mls/hr Xxxx. Xxxxx10 mmol KCl
May 2013 – V0.7 Paediatric Fluid Prescription & Balance Chart 24
4. 4. Prescribe fluidsPrescribe fluids4. 4. Prescribe fluidsPrescribe fluids
Hartmann’s Solution
0.45%Sod. Chl. + 2.5% Glucose0.9% Sodium Chloride
Infusion fluids can also be identified by their Letter
A
B
C
May 2013 – V0.7 Paediatric Fluid Prescription & Balance Chart 25
5. 5. Administer fluidsAdminister fluids5. 5. Administer fluidsAdminister fluids
When completing this section, the following double checks are made:-•Correct patient•Correct medicine•Correct dose •Correct time•Correct route
B 01/01/xx 500 mls12:00 0.9% Sodium Chloride Over 30 minutes Xxxx. Xxxxx
M 01/01/xx 500 mls1230 Hartmann’s Solution 65 mls/hr Xxxx. Xxxxx
O 01/01/xx 500 mls1700 0.9% Sodium Chloride 20 mls/hr Xxxx. Xxxxx10 mmol KCl
- including Batch number & Expiry dateInfusion pump details
Check
May 2013 – V0.7 Paediatric Fluid Prescription & Balance Chart
6.6. Record Intake Record Intake6.6. Record Intake Record Intake
26
Record Site Amount Type Total
for each type of fluid every hour
May 2013 – V0.7 Paediatric Fluid Prescription & Balance Chart
6.6. Record Intake Record Intake6.6. Record Intake Record Intake
27
Record Site Amount Type Total
for each type of fluid every hour
20GRight hand
20GLeft ACFNG
tube
20Ensure
20
20
20
20
2020
20
20
20
20
50
50
5050
50
Hartmann’s
2020
20
20
20
20
2020
20
20
20
20
20
20
0.45% Sod Chl + 2.5% Glucose50
50
50
50
50
0.9% Sodium Chloride
May 2013 – V0.7 Paediatric Fluid Prescription & Balance Chart
6.6. Record Intake Record Intake6.6. Record Intake Record Intake
28
Record Site Amount Type Total
for each type of fluid every hour
20GRight hand
20GLeft ACFNG
tube
20
20
20
20
20
2020
20
20
20
20
50
50
5050
50
2020
20
20
20
20
2020
20
20
20
20
20
20
50
50
50
50
50
* = identify with letter if wish
*B
D
C
Ensure
May 2013 – V0.7 Paediatric Fluid Prescription & Balance Chart 29
20GRight hand
20GLeft ACFNG
tube
20
20
20
20
20
2020
20
20
20
20
50
50
5050
50
2020
20
20
20
20
2020
20
20
20
20
20
20
50
50
50
50
50
7.7. Intake – Cumulative total for each fluid Intake – Cumulative total for each fluid7.7. Intake – Cumulative total for each fluid Intake – Cumulative total for each fluid
Cumulative totals for each type of fluid
B
D
C
Ensure
May 2013 – V0.7 Paediatric Fluid Prescription & Balance Chart 30
20GRight hand
20GLeft ACFNG
tube
20
20
20
20
20
2020
20
20
20
20
50
50
5050
50
2020
20
20
20
20
2020
20
20
20
20
20
20
50
50
50
50
50
7.7. Intake – Cumulative total for each fluid Intake – Cumulative total for each fluid7.7. Intake – Cumulative total for each fluid Intake – Cumulative total for each fluid
Cumulative totals for each type of fluid
B
D
C
20
40
60
80
100
220
140
180
160
200
120
50
100
150
200
250
270
290
310
330
350
510
370
390
410
430
450
470
490
530
50
100
150
200
250
220 530 250
can be totalled at the end of the day
giving totals for each type of fluid
Ensure
May 2013 – V0.7 Paediatric Fluid Prescription & Balance Chart 31
20GRight hand
20GLeft ACFNG
tube
20
20
20
20
20
2020
20
20
20
20
50
50
5050
50
2020
20
20
20
20
2020
20
20
20
20
20
20
50
50
50
50
50
8.8. Intake – Hourly cumulative totals Intake – Hourly cumulative totals8.8. Intake – Hourly cumulative totals Intake – Hourly cumulative totals
B
D
C
20
40
60
80
100
220
140
180
160
200
120
50
100
150
200
250
270
290
310
330
350
510
370
390
410
430
450
470
490
530
50
100
150
200
250
Cumulative totals
to be calculated each hour to get an
Hourly amount inHourly amount in
and then
Grand Total inGrand Total in
220 530 250
Ensure
May 2013 – V0.7 Paediatric Fluid Prescription & Balance Chart 32
20GRight hand
20GLeft ACFNG
tube
20
20
20
20
20
2020
20
20
20
20
50
50
5050
50
2020
20
20
20
20
2020
20
20
20
20
20
20
50
50
50
50
50
B
D
C
20
40
60
80
100
220
140
180
160
200
120
50
100
150
200
250
270
290
310
330
350
510
370
390
410
430
450
470
490
530
50
100
150
200
250
Worked example 2. With cumulative
totalling of Each hour And Each fluid
490
580
650
720
110
180
250
320
390
4020
410
450
790
860
900920
940
980
880
960
1000
40
90
70
70
70
70
70
70
70
2020
20
40
70
70
2020
20
20
20
20
20
8.8. Intake Intake8.8. Intake Intake
220 530 250
Ensure
May 2013 – V0.7 Paediatric Fluid Prescription & Balance Chart 33
9.9. Record intake totals Record intake totals9.9. Record intake totals Record intake totals
780
2201000
200290
490
20
with Day & Night totals if requested by Senior Staff
May 2013 – V0.7 Paediatric Fluid Prescription & Balance Chart
10. 10. Record outputsRecord outputs10. 10. Record outputsRecord outputs
Record Site if necessary Amount Type
for each type of fluid.
34
155
252540
50
5
60
10
20
Drain 1
50
60
25
100
25
20
30
20
5
0
100
75
75
100
50
May 2013 – V0.7 Paediatric Fluid Prescription & Balance Chart
155
252540
50
5
60
10
20
Drain 1
50
60
25
100
25
20
30
20
5
0
100
75
75
100
50
11. 11. Output – Cumulative total for each fluidOutput – Cumulative total for each fluid11. 11. Output – Cumulative total for each fluidOutput – Cumulative total for each fluid
Cumulative totals to be calculated for each type of fluid
35
May 2013 – V0.7 Paediatric Fluid Prescription & Balance Chart
155
252540
50
5
60
10
20
Drain 1
50
60
25
100
25
20
30
20
5
0
100
75
75
100
50
11. 11. Output – Cumulative total for each fluidOutput – Cumulative total for each fluid11. 11. Output – Cumulative total for each fluidOutput – Cumulative total for each fluid
Cumulative totals to be calculated for each type of fluid
36
20
95
75
45
100
95
4035
30
145
105
8055
255
195
305
50
110
210
235
655
380
455
555
20
can be totalled at the end of the day
giving totals for each type of fluid
655 100
235
May 2013 – V0.7 Paediatric Fluid Prescription & Balance Chart
12. 12. Output – Hourly Cumulative totalsOutput – Hourly Cumulative totals12. 12. Output – Hourly Cumulative totalsOutput – Hourly Cumulative totals
Cumulative totals to be calculated for each hour to get an
Hourly amount outHourly amount out
and then
Grand Total outGrand Total out
37
155
252540
50
5
60
10
20
Drain 1
50
60
25
100
25
20
30
20
5
0
100
75
75
100
50
20
95
75
45
100
95
4035
30
145
105
8055
255
195
305
50
110
210
235
655
380
455
555
20
655 100
235
May 2013 – V0.7 Paediatric Fluid Prescription & Balance Chart
155
252540
50
5
60
10
20
Drain 1
50
60
25
100
25
20
30
20
5
0
100
75
75
100
50
20
95
75
45
100
95
4035
30
145
105
8055
255
195
305
50
110
210
235
655
380
455
555
20
12. 12. Output – Hourly Cumulative totalsOutput – Hourly Cumulative totals12. 12. Output – Hourly Cumulative totalsOutput – Hourly Cumulative totals
Cumulative totals to be calculated for each hour to get an
Hourly amount outHourly amount out
and then
Grand Total outGrand Total out
38
20100105110125175200240350440
585
990
890
760
490565
885
208055
15
50
254011090
100
5
175
5075
125
20
655 100
235
May 2013 – V0.7 Paediatric Fluid Prescription & Balance Chart 39
13. 13. Record output totalsRecord output totals13. 13. Record output totalsRecord output totals
655
100
990 235
with Day & Night totals if requested by Senior Staff
38075 25
275
110
125
May 2013 – V0.7 Paediatric Fluid Prescription & Balance Chart
14. 14. Calculate overall hourly balanceCalculate overall hourly balance14. 14. Calculate overall hourly balanceCalculate overall hourly balance
40
Calculate the overall balance each hour
-20-100-85-70-15
550
80
40-30-40
-751565135
100120140
5535
709010
30
490580650
720
110
180250320390
4020
410450
790860
900920940
980
880
960
1000
409070
70
70
70707070
2020
2040
7070
202020
20
20
20
20
20100105110125175200240350440
585
990
890
760
490565
885
208055
15
50
254011090
100
5
175
5075
125
20
May 2013 – V0.7 Paediatric Fluid Prescription & Balance Chart 41
15. 15. Complete overall 24 hour balanceComplete overall 24 hour balance15. 15. Complete overall 24 hour balanceComplete overall 24 hour balance
These boxes must be completed on every patient.
655
100990
235
38075 2
5
275
110
1257802201000
200290 49
0
20
+10
with Day & Night totals if requested by Senior Staff
May 2013 – V0.7 Paediatric Fluid Prescription & Balance Chart 42
16. 16. Record Blood Glucose Record Blood Glucose 16. 16. Record Blood Glucose Record Blood Glucose
Record Blood Glucose when result available
May 2013 – V0.7 Paediatric Fluid Prescription & Balance Chart 43
17. 17. Record SignatureRecord Signature17. 17. Record SignatureRecord Signature
Record signature or initialswhen making entries onto chart
May 2013 – V0.7 Paediatric Fluid Prescription & Balance Chart
18.18. Complete 12 hour assessment Complete 12 hour assessment 18.18. Complete 12 hour assessment Complete 12 hour assessment
Complete 12 hour assessment
Consider questions
44
May 2013 – V0.7 Paediatric Fluid Prescription & Balance Chart 45
19. 19. Start next day’s chartStart next day’s chart19. 19. Start next day’s chartStart next day’s chart
FrontFrontBackBack
i. Labelling
ii. Weight
1000 +10990
iii. Volumes
May 2013 – V0.7 Paediatric Fluid Prescription & Balance Chart 46
Fluid Prescription/Balance ChartFluid Prescription/Balance ChartFluid Prescription/Balance ChartFluid Prescription/Balance Chart