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首页> 外文期刊>Pediatrics: Official Publication of the American Academy of Pediatrics >Improving Isotonic Maintenance Intravenous Fluid Use in the Emergency Department
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Improving Isotonic Maintenance Intravenous Fluid Use in the Emergency Department

机译：改善紧急部门的等渗维性静脉注射液

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摘要

BACKGROUND Maintenance intravenous fluids (IVFs) are commonly used in the hospital setting. Hypotonic IVFs are commonly used in pediatrics despite concerns about high incidence of hyponatremia. We aimed to increase isotonic maintenance IVF use in children admitted from the emergency department (ED) from a baseline of 20% in 2018 to >80% by December 2019. METHODS We included patients aged 28 days to 18 years receiving maintenance IVFs (rate >10 mL/hour) at the time of admission. Patients with active chronic medical problems were excluded. Interventions included institutional discussions on isotonic IVF based on literature review, education on isotonic IVF use per the American Academy of Pediatrics guideline (isotonic IVF use with appropriate potassium chloride and dextrose), electronic medical record changes to encourage isotonic IVF use, and group practice review with individual physician audit and feedback. Balancing measures were the frequency of serum electrolyte checks within 24 hours of ED admission and occurrence of hypernatremia. Data were analyzed by using statistical process control charts. RESULTS Isotonic maintenance IVF use improved, with special cause observed twice; the 80% goal was met and sustained. No difference was noted in serum electrolyte checks within 24 hours of admission (P > .05). There was no increase in occurrence of hypernatremia among patients who received isotonic IVF compared with those who received hypotonic IVF (P > .05). CONCLUSIONS The application of improvement methods resulted in improved isotonic IVF use in ED patients admitted to the inpatient setting. Institutional readiness for change at the time of the American Academy of Pediatrics guideline release and hardwiring of preferred fluids via electronic medical record changes were critical to success.
机译：背景维持性静脉输液（IVF）在医院环境中常用。尽管人们担心低钠血症的发生率很高，但低渗IVF在儿科仍被广泛使用。我们的目标是将急诊科（ED）住院儿童的等渗维持体外受精使用率从2018年的20%提高到2019年12月的80%以上。方法我们纳入了28天至18岁的患者，他们在入院时接受维持性IVFs（速率>10ml/小时）。排除患有活动性慢性疾病的患者。干预措施包括基于文献综述的等渗IVF的机构讨论、根据美国儿科学会指南进行的等渗IVF使用教育（使用适当的氯化钾和葡萄糖进行等渗IVF）、鼓励等渗IVF使用的电子病历更改，以及有个别医生审核和反馈的团体实践审查。平衡措施是急诊入院后24小时内进行血清电解质检查的频率和高钠血症的发生率。数据采用统计过程控制图进行分析。结果等渗维持IVF使用率提高，特殊原因观察2次；80%的目标得到了实现和维持。入院后24小时内，血清电解质检查无差异（P>0.05）。与接受低张IVF的患者相比，接受等张IVF的患者的高钠血症发生率没有增加（P>0.05）。结论改进方法的应用提高了住院ED患者等渗IVF的使用。在美国儿科学会（American Academy of Pediatrics）指南发布时，机构对变革的准备，以及通过电子病历变更对首选液体进行硬接线，对成功至关重要。

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