Drowning in antibiotics.

Area of Science:

• Medical Auditing
• Patient Safety
• Fluid Management

Background:

• The National Confidential Enquiry into Perioperative Deaths (NCEPOD) highlighted the critical importance of intravenous (IV) fluid prescribing, recommending it receive the same attention as drug prescribing.
• Fluid prescription is often managed by junior doctors, despite its complexity, and the fluid used to dilute antibiotics is frequently overlooked in daily fluid balance calculations.

Purpose of the Study:

• To conduct a closed-loop audit assessing compliance with National Institute for Health and Care Excellence (NICE) guidelines for intravenous (IV) fluid and electrolyte therapy.
• To evaluate the impact of additional fluid administered with antibiotics on overall fluid balance and electrolyte prescribing.

Main Methods:

• Two retrospective audit cycles were performed to analyze total fluid and electrolyte intake.
• Compliance with NICE guidelines was assessed, comparing fluid administration with and without the inclusion of antibiotic dilution fluid.
• Changes in practice between cycles included the introduction of potassium chloride with sodium chloride and glucose (PSG) and mandatory antibiotic bolusing.

Main Results:

• In the first audit cycle, only 10.4% of patients accurately met their daily fluid requirements. This improved slightly to 7.45% in the second cycle.
• The mean additional fluid volume administered with antibiotics over 3 days was 1,572.73ml in cycle 1.
• Following the introduction of mandatory antibiotic bolusing in cycle 2, this additional fluid volume decreased significantly to 469.44ml.

Conclusions:

• Patients receiving IV fluids and IV antibiotics often receive excessive fluid when the dilution volume of antibiotics is considered.
• Implementing antibiotic bolusing reduced both the amount of additional fluid and the incidence of electrolyte complications.
• Training nurses to administer antibiotics as a bolus is recommended to mitigate fluid-related complications and improve patient safety.