Keeping the Home in Homeostasis - Saving bed days through an outpatient blood monitoring service with day case intravenous fluid and electrolyte replacement
by Margaret Collins
Poster Download
Background
Patients with high output ileostomy or malabsorption frequently require intravenous (IV) replacement therapy to maintain health. This patient cohort are at risk of re-admission with acute kidney injury.
Aims
- Allow safe discharge of those patients reliant on frequent IV fluids and/or electrolytes.
- Reduce the incidence of re-admission with AKI and deranged electrolytes.
Method
The Nutrition Support Team identified patients at risk of dehydration and electrolyte imbalance. A nurse-led blood monitoring service was set up with day case attendance for IV fluid and electrolyte replacement as required. IV fluids and electrolytes were predominantly prescribed by the specialist nurse. The NST multidisciplinary team guided ongoing management of complex patients. Face-to-face follow up was achieved in parallel to day case attendance for IV replacement or at the NST outpatient clinic.
Results
Estimated bed-days saved avoiding a 5 day re-admission with AKI per 6 months
Jul–Dec 2015: 45
Jan-Dec 2016: 350
Estimated bed-days saved avoiding 2 day inpatient stay for IV magnesium
Jul–Dec 2015: 6
Jan-Dec 2016: 60
Actual bed-days saved by avoiding extended length of inpatient stay
Jul–Dec 2015: 98
Jan-Dec 2016: 799
Total bed-days saved
Jul–Dec 2015: 149
Jan-Dec 2016: 1209
Conclusion:
The NST outpatient blood monitoring service, with day case IV fluid and electrolyte replacement saves bed days and keeps patients at home. It allows at risk patients to avoid lengthy inpatient stay and readmission with AKI. The multidisciplinary NST delivers comprehensive management of a complex patient group. Independent nurse prescribing enhances the efficiency of the service. This service is on-going.