DOI: 10.1093/bjs/znad258.174 ISSN:

1039 Preventing Avoidable Harm with Safe IV Fluid Therapy – a Closed Loop Audit

S W U Hassan, S N Alam, M Shoaib, M Ibrahim
  • Surgery



The National Institute for Health and Care Excellence (NICE) states that one in five people on intravenous (IV) fluids suffer from complications or morbidity due to their inappropriate administration. We aimed to compare our Trust’s current IV fluid prescription practices to standards set out in the NICE CG174 guidelines.


We retrospectively reviewed 50 case notes for patients admitted to the Acute Medical Unit. We evaluated if hydration status was assessed comprehensively, and if resuscitation and maintenance fluids were prescribed appropriately, according to the NICE CG174 guidelines. The findings were presented at a local meeting and interventions were implemented by putting up posters and conducting regular teaching sessions on safe IV fluid prescription. To close the audit loop, data from a further 50 patients was collected post-intervention.


The first audit cycle showed poor overall compliance with the guidelines; however a significant improvement was noted post-intervention. Pre-intervention, only 10% of patients had regular hydration assessments, 32% of patients received fluid resuscitation appropriately, and while 52% of our sample received maintenance fluid when indicated, 0% received the correct composition. Post-intervention, these figures rose to 28%, 66%, 84% and 15% respectively.


Inappropriate fluid administration is a risk to patient safety. This audit highlighted several areas for improvement regarding IV fluid prescription, and although a significant change was noted, further work is needed to increase compliance. We hope to incorporate the topic of IV fluids into the hospital’s regular teaching programmes to sustainably improve IV fluid prescription practices across the Trust.

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