World Health Organisation checklist and glycaemic control

Bhadresha, S.; Leyden, Kathryn; Ellis, Samantha

doi:10.1111/j.1365-2044.2009.06141_2.x

Cited by 2 publications

(5 citation statements)

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“…Previous data have suggested there may be a 30% incidence of hyponatraemia in postoperative patients given fluids and a VRIII . This was not the case in our study, even when hypotonic solutions were used to accompany the VRIII.…”

Section: Discussioncontrasting

confidence: 61%

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Slipping up on the sliding scale: fluid and electrolyte management in variable rate intravenous insulin infusions

et al. 2016

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This study aimed to analyse variations in intravenous fluid therapy and electrolyte management with variable rate intravenous insulin infusions (VRIIIs); and to quantify serum electrolyte changes pre‐ versus post‐VRIII and variations therein depending on supplemented fluid electrolyte compositions. A retrospective study was undertaken involving 174 VRIIIs prescribed over a 10‐week period at a tertiary teaching hospital. Each VRIII had their associated fluid prescription and serum electrolytes analysed. The results showed that 5% dextrose (46%) and 0.9% NaCl (34%) were the most commonly prescribed fluids; 64% of fluids did not have the recommended potassium supplementation. Administration of a VRIII resulted in a significant drop in serum potassium levels (p < 0.0001) for those who did not receive supplementation. There was no drop in serum potassium for those patients who did receive supplemental potassium. Eleven patients (6.4%) developed new‐onset hypokalaemia (K ≤3.5 mmol/L) after implementation of a VRIII. Our study supports the hypothesis that VRIIIs cause hypokalaemia and that this can be averted by supplemental potassium, thus preventing potentially avoidable hypokalaemic complications. A large variation exists in prescribing fluids with VRIIIs. Introduction of the national surgical and medical VRIII guidelines, together with improved availability to recommended fluids, and a quality improvement project, are our next steps to improve patient outcomes. Copyright © 2016 John Wiley & Sons.

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Section: Discussioncontrasting

confidence: 61%

“…Bhadresha et al . recorded a hyponatraemia incidence of 30% when a VRIII with a 5% glucose solute was initiated in postoperative patients …”

Section: Introductionmentioning

confidence: 99%

Slipping up on the sliding scale: fluid and electrolyte management in variable rate intravenous insulin infusions

et al. 2016

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“…While there is limited research on the frequency of adverse events associated with VRIII, the evidence that is available shows high rates of adverse events 2 5–7. A local audit undertaken at our centre in 2015 showed a significant fall in potassium levels and high rate of hypokalaemia associated with inappropriate fluid administration alongside intravenous insulin 3.…”

Section: Introductionmentioning

confidence: 96%

“…The National Diabetes Audit (NaDIA) in 2015 showed a national average of hypoglycaemia in 20% of VRIII episodes,7 while the 2011 NaDIA found that 3.3% of patients had hypoglycaemia (<4 mmol/L) >25% of the time while on VRIII 6. Bhadresha et al found 30% of VRIII episodes were associated with hyponatraemia when glucose 5% was used as a substrate 5. As well as this, monitoring of glucose measurements while on a VRIII, which is paramount for their safe usage, is often poor, as shown in the 2011 NaDIA with 6.4% of patients on a VRIII having <4 glucose measurements in the preceding 24 hours 6…”

Section: Introductionmentioning

confidence: 99%

“…6 Bhadresha et al found 30% of VRIII episodes were associated with hyponatraemia when glucose 5% was used as a substrate. 5 As well as this, monitoring of glucose measurements while on a VRIII, which is paramount for their safe usage, is often poor, as shown in the 2011 NaDIA with 6.4% of patients on a VRIII having <4 glucose measurements in the preceding 24 hours. 6…”

Section: Introductionmentioning

confidence: 99%

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A quality improvement project reducing adverse events and improving adherence to guidelines surrounding VRIII usage

et al. 2022

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Variable rate intravenous insulin infusions (VRIII) are frequently used in hospitals and incorrect use can lead to electrolyte imbalance, hypoglycaemia and adverse outcomes. The Joint British Diabetes Societies (JDBS) published guidelines in 2014 and recommended the use of a balanced fluid as substrate. There was no published data to demonstrate the superiority of this fluid in reducing adverse events. This quality improvement project aimed to review the existing practice at our Trust in accordance with JDBS guidelines. We predicted introducing this fluid would reduce adverse events and demonstrating this was a prerequisite condition from our Trust Medicines Management Committee to approve its long-term availability. We carried out an audit of our practice in 2015, at which time the JBDS recommended fluid (0.45% sodium chloride/5% dextrose with 0.15% potassium chloride) was not available in our Trust. Our VRIII guideline was re-written with recommendation for use of the balanced fluid, after procurement from pharmacy. Our primary areas for improvement as highlighted from the 2015 audit were correct substrate prescription and rate reduction of hypokalaemia (potassium <3.5 mmol/L) and hypoglycaemia (glucose <4 mmol/L) during VRIII use. Analysis of the pre-intervention (December 2016) and post-intervention (September–November 2017) data showed a significant increase in correct fluid use; 11% pre-intervention to 76% post-intervention (χ2, p<0.0001). The number of hypoglycaemic events per VRIII reduced from 0.73 (±1.78) to 0.28 (±0.84) (p<0.05) peri-intervention. Similarly, the number of hypokalaemic events per VRIII reduced from 0.15 (±0.54) pre-intervention to 0.05 (±0.25) post-intervention. There was also a significant reduction in number of VRIII episodes associated with a hyponatraemia event from 26% at baseline to 12% post-intervention (p<0.01). Some of these marked improvements were not sustained at 1-year post follow-up. We reduced adverse outcomes with a substantial net-cost saving during this period, through implementation of new and accessible guidelines, trust-wide education programmes and posters to raise awareness.

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World Health Organisation checklist and glycaemic control

Cited by 2 publications

References 0 publications

Slipping up on the sliding scale: fluid and electrolyte management in variable rate intravenous insulin infusions

Slipping up on the sliding scale: fluid and electrolyte management in variable rate intravenous insulin infusions

A quality improvement project reducing adverse events and improving adherence to guidelines surrounding VRIII usage

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