Adequacy of monitoring of intravenous Fluids in elderly patients in Kenyatta National hospital

Abstract

Background Iatrogenic problems arising from inappropriate IV fluid therapy can increase morbidity and prolong hospital stay. Among those at risk, are the elderly patients as they have a high burden of cardio respiratory and renal diseases. Volumes and types of IV fluids will vary depending on the clinical scenario. Therefore, monitoring of fluid balance parameters is crucial and should remain consistent regardless of the clinical indications for IV fluids. Research has revealed gaps in the monitoring of fluid balance among the elderly patients. Objective The study thus aimed to establish if IV fluids were prescribed rationally and to determine if fluid balance was adequately monitored in elderly patients. Methodology This was a longitudinal descriptive study. All elderly patients who met the inclusion criteria, between March and July 2010 in Kenyatta National Hospital, were followed up until the day of discharge or death. A universal sample of 150 patients was obtained. The data obtained were entered into a structured data collection form. The data were analyzed using SPSS 12.0 software. Descriptive data analysis was performed on all variables. Exploratory data analysis was done to assess variables for associations and correlations. Multivariate logistic regression was done to control for confounding. Results A good majority of the patients (87.3 %) had IV fluids rationally prescribed. About 79.3 % had their baseline UEC determined. The most commonly prescribed IV fluid was Normal saline. The IV fluid most prone to administration errors was Normal saline alternating with 5 % dextrose. About 25 % of the patients either had no prescriptions for IV fluids or had incomplete prescriptions, though they received IV fluids. Weight and fluid charting were the least frequently monitored parameters. In contrast, vital signs and clinical signs and symptoms were the most frequently monitored (98 %). Determination of baseline UEC, duration of hospital stay and duration of IV fluid administration were found to be significantly associated with adequate monitoring. (P<0.05) x Conclusion and recommendations The study found that only 50% of the patients were noted to have had their fluid balance parameters adequately monitored. Lack of clarity of some of the prescriptions may have contributed to errors observed. Redesigning of the IV fluid prescription segment of the treatment sheet will go a long way in ensuring clarity ofthe prescription. Continuous Medical Education should be encouraged so as to stress the need to give IV fluid prescriptions just as much importance as is given to other medication. Xl