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HSC Trust’s Policy Collaborative

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.

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HSC Trust’s Policy Collaborative

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  1. HSC Trust’s Policy Collaborative Paediatric Fluid Prescription & Balance Chart Roll out - 2013

  2. 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. Aims and outcomes of session. paediatric fluid prescription & balance chart.

  3. NPSA alert 22

  4. Front

  5. Back

  6. 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.

  7. 1. Labelling Front Back and • Stick on labels and complete hospital, ward & date • on both sides of chart

  8. 2. Insert patient’s weight in kgs The weight used must be a recent weight Indicate whether estimated or measured & when.

  9. 3. Complete previous days fluid volumes

  10. For information on Prescribing fluids Administering fluids Completing fluid balance chart Recording intake Recording output Recording balance Start next days chart •  slide 11 •  slide 25 • slide 26 • slide 26 • slide 34 • slide 40 • slide 45

  11. Method for prescribing fluids based on:-

  12. Thus, fluid prescription based upon:- Shock  Fluid Bolus Correct deficit Maintenance Ongoing fluid losses

  13. Method for prescribing fluids:- Shock  Fluid Bolus Maintenance Correct deficit Ongoing fluid losses

  14. Method for prescribing fluids:- Shock  Fluid Bolus Maintenance Correct deficit Ongoing fluid losses

  15. Method for prescribing fluids:- If fluid bolus required  • calculate volume • prescribe • record indication as Shock  Fluid Bolus B B B B B 01/01/xxxx 500 mls 12:00 0.9% Sodium Chloride

  16. Method for prescribing fluids:- Calculate maintenance requirements • record indication as M Shock  Fluid Bolus Maintenance

  17. Method for prescribing fluids:- Calculate maintenance requirements • record indication as M Shock  Fluid Bolus Maintenance M B 01/01/xxxx 500 mls 12:00 0.9% Sodium Chloride M 01/01/xxxx 500mls 12.30 Hartmann’s Solution

  18. Method for prescribing fluids:- Is there a fluid deficit? • calculate correction • prescribe • record indication as D Shock  Fluid Bolus Maintenance Correct deficit

  19. Method for prescribing fluids:- Shock  Fluid Bolus Maintenance Correct deficit B 01/01/xxxx 500 mls 12:00 0.9% Sodium Chloride M 01/01/xxxx 500mls 12:30 Hartmann’s Solution D 01/01/xxxx 500mls 12:30 0.9% Sodium Chloride

  20. Method for prescribing fluids:- If there are any ongoing losses • calculate • prescribe • record indication as O Shock  Fluid Bolus Maintenance Correct deficit Ongoing fluid losses

  21. Method for prescribing fluids:- Shock  Fluid Bolus Maintenance Correct deficit Ongoing fluid losses B 01/01/xxxx 500 mls 12:00 0.9% Sodium Chloride M 01/01/xxxx 500mls 12:30 Hartmann’s Solution D 01/01/xxxx 500mls 12:30 0.9% Sodium Chloride O 01/01/xxxx 500mls 17:00 0.9% Sodium Chloride

  22. 4. Prescribe fluids 01/01/xx 12:00 500 mls B 0.9% Sodium Chloride Xxxx. Xxxxx Over 30 minutes 01/01/xx 1230 500 mls M Xxxx. Xxxxx 65 mls/hr Hartmann’s Solution 01/01/xx 1700 10 mmol KCl 500 mls O 0.9% Sodium Chloride Xxxx. Xxxxx 20 mls/hr Example 1: Based on 25 kg child.

  23. 4. Prescribe fluids * 01/01/xx 0.9% Sodium Chloride B 500 mls 12:00 Over 30 minutes Xxxx. Xxxxx 01/01/xx M 500 mls 1230 65 mls/hr Xxxx. Xxxxx Hartmann’s Solution 0.9% Sodium Chloride O 500 mls 01/01/xx 1700 10 mmol KCl Xxxx. Xxxxx 20 mls/hr * Medicines must be recorded in Drug Kardex

  24. 4. Prescribe fluids 0.45%Sod. Chl. + 2.5% Glucose A 0.9% Sodium Chloride B Hartmann’s Solution C Infusion fluids can also be identified by their Letter

  25. 5. Administer fluids 01/01/xx 0.9% Sodium Chloride B 500 mls 12:00 Over 30 minutes Xxxx. Xxxxx 01/01/xx M 500 mls 1230 65 mls/hr Xxxx. Xxxxx Hartmann’s Solution 0.9% Sodium Chloride O 500 mls 01/01/xx 1700 10 mmol KCl Xxxx. Xxxxx 20 mls/hr • When completing this section, the following double checks are made:- • Correct patient • Correct medicine • Correct dose • Correct time • Correct route Check - including Batch number & Expiry date Infusion pump details

  26. 6. Record Intake • Record • Site • Amount • Type • Total • for each type of fluid • every hour

  27. 6. Record Intake 20G Left ACF 20G Right hand NG tube • Record • Site • Amount • Type • Total • for each type of fluid • every hour Ensure 20 Hartmann’s 20 20 50 20 50 20 50 20 50 20 50 0.9% Sodium Chloride 20 20 20 20 20 0.45% Sod Chl + 2.5% Glucose 50 20 20 50 20 50 20 50 20 50 20 20 20 20 20 20 20 20

  28. 6. Record Intake 20G Left ACF 20G Right hand NG tube • Record • Site • Amount • Type • Total • for each type of fluid • every hour Ensure 20 20 B * 20 50 20 50 20 50 20 50 20 50 20 C 20 20 20 20 D 50 20 20 50 20 50 20 50 20 50 20 20 * = identify with letter if wish 20 20 20 20 20 20

  29. 7. Intake – Cumulative total for each fluid 20G Left ACF 20G Right hand NG tube • Cumulative totals for • each type of fluid Ensure 20 20 B 20 50 20 50 20 50 20 50 20 50 20 C 20 20 20 20 D 50 20 20 50 20 50 20 50 20 50 20 20 20 20 20 20 20 20

  30. 7. Intake – Cumulative total for each fluid 20G Left ACF 20G Right hand NG tube • Cumulative totals for • each type of fluid Ensure 20 20 • can be totalled at the end of the day • giving totals for each type of fluid 20 40 B 20 50 50 60 20 100 80 50 20 150 100 50 20 120 50 200 20 50 250 140 20 C 160 20 180 20 270 20 20 D 290 200 50 50 20 20 310 220 100 50 20 330 50 150 350 20 50 200 370 20 50 390 250 20 20 410 20 430 20 450 20 470 20 490 20 510 20 530 220 530 250

  31. 8. Intake – Hourly cumulative totals 20G Left ACF 20G Right hand NG tube • Cumulative totals to be calculated • each hour • to get an Hourly amount in and then Grand Total in Ensure 20 20 20 40 B 20 50 50 60 20 100 80 50 20 150 100 50 20 120 50 200 20 50 250 140 20 C 160 20 180 20 270 20 20 D 290 200 50 50 20 20 310 220 100 50 20 330 50 150 350 20 50 200 370 20 50 390 250 20 20 410 20 430 20 450 20 470 20 490 20 510 20 530 220 530 250

  32. 8. Intake 20G Left ACF 20G Right hand NG tube • Worked example 2. • With cumulative totalling of • Each hour • And • Each fluid Ensure 20 20 20 20 20 40 20 40 B 70 110 20 50 50 60 70 180 20 100 80 50 20 70 250 150 100 50 20 70 320 120 50 200 20 70 390 50 250 140 20 20 410 C 160 20 40 450 180 20 270 40 490 20 20 D 290 200 50 50 90 580 20 20 310 220 100 50 70 650 20 330 50 150 720 70 350 20 50 790 200 370 20 70 50 390 250 860 20 70 20 410 880 20 20 430 900 20 920 20 20 450 940 20 20 470 960 20 20 490 980 20 20 510 20 530 20 1000 530 220 250

  33. 9. Record intake totals 220 200 20 290 490 780 1000 with Day & Night totals if requested by Senior Staff

  34. 10. Record outputs Drain 1 • Record • Site if necessary • Amount • Type • for each type of fluid. 20 50 20 10 5 5 15 25 25 25 40 60 50 30 60 50 75 20 100 75 0 25 100 5 100

  35. 11. Output – Cumulative total for each fluid Drain 1 • Cumulative totals to be calculated for • each type of fluid 20 50 20 10 5 5 15 25 25 25 40 60 50 30 60 50 75 20 100 75 0 25 100 5 100

  36. 11. Output – Cumulative total for each fluid Drain 1 • Cumulative totals to be calculated for • each type of fluid 20 20 20 50 50 30 20 10 5 35 5 40 55 15 45 80 25 25 25 105 145 40 110 195 60 50 75 30 255 60 305 50 380 • can be totalled at the end of the day • giving totals for each type of fluid 75 95 20 455 100 210 75 95 0 235 555 25 100 100 5 655 100 100 235 655

  37. 12. Output – Hourly Cumulative totals Drain 1 • Cumulative totals to be calculated for • each hour • to get an Hourly amount out and then Grand Total out 20 20 20 50 50 30 20 10 5 35 5 40 55 15 45 80 25 25 25 105 145 40 110 195 60 50 75 30 255 60 305 50 380 75 95 20 455 100 210 75 95 0 235 555 25 100 100 5 655 100 100 235 655

  38. 12. Output – Hourly Cumulative totals Drain 1 • Cumulative totals to be calculated for • each hour • to get an Hourly amount out and then Grand Total out 20 20 20 20 20 100 50 80 50 30 20 10 105 5 5 35 110 5 5 40 125 15 55 15 45 175 50 80 25 25 200 25 25 105 145 40 240 40 110 195 350 60 110 50 75 30 440 255 60 90 490 50 305 50 565 75 380 75 20 95 20 585 455 100 760 210 175 75 95 0 885 125 235 555 25 100 100 5 5 890 100 655 100 990 100 235 655

  39. 13. Record output totals 655 275 380 100 75 25 235 125 110 990 with Day & Night totals if requested by Senior Staff

  40. 14. Calculate overall hourly balance • Calculate the overall balance • each hour -20 20 20 -100 100 80 -85 105 20 20 5 -70 110 20 40 5 -15 125 15 70 110 5 175 50 70 180 50 200 70 250 25 80 70 240 320 40 350 70 390 110 40 440 -30 90 20 410 490 50 -40 40 450 565 75 -75 40 490 15 90 580 20 70 650 65 585 720 135 70 790 30 760 175 70 860 70 100 120 880 20 900 140 20 885 125 35 920 20 940 55 20 5 960 890 20 70 980 20 90 100 20 10 1000 990

  41. 15. Complete overall 24 hour balance 275 380 655 220 200 20 100 75 25 290 780 490 110 235 125 +10 1000 990 These boxes must be completed on every patient. with Day & Night totals if requested by Senior Staff

  42. 16. Record Blood Glucose Record Blood Glucose when result available

  43. 17. Record Signature Record signature or initials when making entries onto chart

  44. 18. Complete 12 hour assessment • Complete 12 hour assessment • Consider questions

  45. 19. Start next day’s chart i. Labelling Front Back ii. Weight iii. Volumes +10 1000 990

  46. Fluid Prescription/Balance Chart

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