PEDIATRIC FLUID DOCUMENTATION – A
SYSTEMATIC APPROACH TO CHANGING PRACTICE
Stephens LJ
Royal Children’s Hospital, Melbourne, Australia
Objective: Nursing as a profession is obligated to
demonstrate that practices that have become standard are in fact, efficient
and effective. In a routine review of adverse events the area of fluid
documentation of pediatric fluid delivery was identified as in need of
revision. A multidisciplinary clinical research project was developed to
provide evidence for changes to current practice, and to improve the
standard of fluid documentation. The main objectives of the project were:
to identify current research literature on the topic; to conduct a clinical
review of current fluid documentation practices; to develop recommendations
for changing practice.
Method: Current research and expert opinion was
identified via medical texts, peer reviewed journals, and medical and
nursing clinicians at the author’s institution. A clinical review was
conducted on all inpatients within a 24-hour period and data was collected
with respect to all aspects of documentation of fluid therapy. Themes
arsing from the review were communicated widely via institutional forum and
clinical practice review, and feedback was incorporated into the final
recommendations for practice.
Results: Data was collected on a total of 159 patients.
The review highlighted many problems with documentation affecting all
staff. Recommendations included implementing criteria for identification of
patients requiring fluid balance monitoring, reformatting fluid therapy
charts, and standardisation of documenting practices and terminology. Conclusions: Pediatric fluid therapy documentation poses some
significant dilemmas for current practice. By adopting a multidisciplinary
collaborative approach a process for change can be developed, and evidence
based practices implemented within the clinical area. Recommendations have
been implemented throughout the institution, and are currently being
evaluated for effectiveness.