May 2013 – V0.7 Paediatric Fluid Prescription & Balance Chart HSC Trust’s Policy Collaborative

May 2013 – V0.7 Paediatric Fluid Prescription & Balance Chart Aims and outcomes of session. Aim:  To instruct staff on the correct completion of the Outcomes: Demonstrate the ability to:  calculate and complete fluid prescription.  correctly administer fluids.  correctly complete a fluid balance chart. 2 paediatric fluid prescription & balance chart.

May 2013 – V0.7 Paediatric Fluid Prescription & Balance Chart NPSA alert 22 3

May 2013 – V0.7 Paediatric Fluid Prescription & Balance Chart 4 Front

May 2013 – V0.7 Paediatric Fluid Prescription & Balance Chart 5 Back

May 2013 – V0.7 Paediatric Fluid Prescription & Balance Chart  Chart must be used for children  aged from 4 weeks up to their 16 th birthday  throughout each of the 5 HSC Trusts  wherever their care is provided.  Except for patients  cared for in ICUs, HDUs, specialist units  with diabetic ketoacidosis  with acute burns.  who may use different fluid prescription charts. 6

May 2013 – V0.7 Paediatric Fluid Prescription & Balance Chart 1. Labelling 7  Stick on labels and complete hospital, ward & date  on both sides of chart Front Back and

May 2013 – V0.7 Paediatric Fluid Prescription & Balance Chart 2. Insert patient’s weight in kgs 8 The weight used must be a recent weight Indicate whether estimated or measured & when.

May 2013 – V0.7 Paediatric Fluid Prescription & Balance Chart 3. Complete previous days fluid volumes 9

May 2013 – V0.7 Paediatric Fluid Prescription & Balance Chart Prescribing fluids Administering fluids Completing fluid balance chart Recording intake Recording output Recording balance Start next days chart 10 For information on  slide 11  slide 25  slide 26  slide 34  slide 40  slide 45

May 2013 – V0.7 Paediatric Fluid Prescription & Balance Chart 11 Method for prescribing fluids based on:-

May 2013 – V0.7 Paediatric Fluid Prescription & Balance Chart 12 Thus, fluid prescription based upon:- Shock  Fluid Bolus Maintenance Correct deficit Ongoing fluid losses

May 2013 – V0.7 Paediatric Fluid Prescription & Balance Chart 13 Method for prescribing fluids:- Shock  Fluid Bolus Maintenance Correct deficit Ongoing fluid losses

May 2013 – V0.7 Paediatric Fluid Prescription & Balance Chart 14 Method for prescribing fluids:- Shock  Fluid Bolus Maintenance Correct deficit Ongoing fluid losses

May 2013 – V0.7 Paediatric Fluid Prescription & Balance Chart 15 Method for prescribing fluids:- Shock  Fluid Bolus If fluid bolus required   calculate volume  prescribe  record indication as B 01/01/xxxx500 mls 12:00 0.9% Sodium Chloride B B B B

May 2013 – V0.7 Paediatric Fluid Prescription & Balance Chart 16 Method for prescribing fluids:- Shock  Fluid Bolus Maintenance Calculate maintenance requirements  record indication as M

May 2013 – V0.7 Paediatric Fluid Prescription & Balance Chart 17 Method for prescribing fluids:- Shock  Fluid Bolus Maintenance Calculate maintenance requirements  record indication as M B 01/01/xxxx500 mls 12:00 0.9% Sodium Chloride M 01/01/xxxx500mls Hartmann’s Solution M

May 2013 – V0.7 Paediatric Fluid Prescription & Balance Chart 18 Method for prescribing fluids:- Shock  Fluid Bolus Maintenance Correct deficit Is there a fluid deficit?  calculate correction  prescribe  record indication as D

May 2013 – V0.7 Paediatric Fluid Prescription & Balance Chart 19 Method for prescribing fluids:- Shock  Fluid Bolus Maintenance Correct deficit B 01/01/xxxx500 mls 12:00 0.9% Sodium Chloride M 01/01/xxxx500mls 12:30 Hartmann’s Solution D 01/01/xxxx500mls 12:30 0.9% Sodium Chloride

May 2013 – V0.7 Paediatric Fluid Prescription & Balance Chart 20 Method for prescribing fluids:- Shock  Fluid Bolus Maintenance Correct deficit Ongoing fluid losses If there are any ongoing losses  calculate  prescribe  record indication as O

May 2013 – V0.7 Paediatric Fluid Prescription & Balance Chart 21 Method for prescribing fluids:- Shock  Fluid Bolus Maintenance Correct deficit Ongoing fluid losses B 01/01/xxxx500 mls 12:00 0.9% Sodium Chloride M 01/01/xxxx500mls 12:30 Hartmann’s Solution D 01/01/xxxx500mls 12:30 0.9% Sodium Chloride O 01/01/xxxx500mls 17:00 0.9% Sodium Chloride

May 2013 – V0.7 Paediatric Fluid Prescription & Balance Chart Prescribe fluids B 01/01/xx 500 mls 12:00 0.9% Sodium Chloride Over 30 minutes Xxxx. Xxxxx M 01/01/xx 500 mls 1230 Hartmann’s Solution 65 mls/hr Xxxx. Xxxxx O 01/01/xx 500 mls % Sodium Chloride 20 mls/hr Xxxx. Xxxxx 10 mmol KCl Example 1: Based on 25 kg child. Example 1: Based on 25 kg child.

May 2013 – V0.7 Paediatric Fluid Prescription & Balance Chart Prescribe fluids * * Medicines must be recorded in Drug Kardex B 01/01/xx 500 mls 12:00 0.9% Sodium Chloride Over 30 minutesXxxx. Xxxxx M 01/01/xx 500 mls 1230 Hartmann’s Solution 65 mls/hrXxxx. Xxxxx O 01/01/xx 500 mls % Sodium Chloride 20 mls/hr Xxxx. Xxxxx10 mmol KCl

May 2013 – V0.7 Paediatric Fluid Prescription & Balance Chart Prescribe fluids Hartmann’s Solution 0.45%Sod. Chl % Glucose 0.9% Sodium Chloride Infusion fluids can also be identified by their Letter A B C

May 2013 – V0.7 Paediatric Fluid Prescription & Balance Chart Administer fluids When completing this section, the following double checks are made:- Correct patient Correct medicine Correct dose Correct time Correct route B 01/01/xx 500 mls 12:00 0.9% Sodium Chloride Over 30 minutesXxxx. Xxxxx M 01/01/xx 500 mls 1230 Hartmann’s Solution 65 mls/hrXxxx. Xxxxx O 01/01/xx 500 mls % Sodium Chloride 20 mls/hr Xxxx. Xxxxx10 mmol KCl - including Batch number & Expiry date Infusion pump details Check

May 2013 – V0.7 Paediatric Fluid Prescription & Balance Chart 6. Record Intake 26  Record  Site  Amount  Type  Total  for each type of fluid  every hour

May 2013 – V0.7 Paediatric Fluid Prescription & Balance Chart 6. Record Intake 27  Record  Site  Amount  Type  Total  for each type of fluid  every hour 20G Right hand 20G Left ACF NG tube 20 Ensure Hartmann’s % Sod Chl + 2.5% Glucose % Sodium Chloride

May 2013 – V0.7 Paediatric Fluid Prescription & Balance Chart 6. Record Intake 28  Record  Site  Amount  Type  Total  for each type of fluid  every hour 20G Right hand 20G Left ACF NG tube * = identify with letter if wish * B D C Ensure

May 2013 – V0.7 Paediatric Fluid Prescription & Balance Chart 29 20G Right hand 20G Left ACF NG tube Intake – Cumulative total for each fluid  Cumulative totals for  each type of fluid B D C Ensure

May 2013 – V0.7 Paediatric Fluid Prescription & Balance Chart 30 20G Right hand 20G Left ACF NG tube Intake – Cumulative total for each fluid  Cumulative totals for  each type of fluid B D C  can be totalled at the end of the day  giving totals for each type of fluid Ensure

May 2013 – V0.7 Paediatric Fluid Prescription & Balance Chart 31 20G Right hand 20G Left ACF NG tube Intake – Hourly cumulative totals B D C  Cumulative totals to be calculated  each hour  to get an Hourly amount in and then Grand Total in Ensure

May 2013 – V0.7 Paediatric Fluid Prescription & Balance Chart 32 20G Right hand 20G Left ACF NG tube B D C  Worked example 2.  With cumulative totalling of Each hour And Each fluid Intake Ensure

May 2013 – V0.7 Paediatric Fluid Prescription & Balance Chart Record intake totals with Day & Night totals if requested by Senior Staff

May 2013 – V0.7 Paediatric Fluid Prescription & Balance Chart 10. Record outputs  Record  Site if necessary  Amount  Type  for each type of fluid Drain

May 2013 – V0.7 Paediatric Fluid Prescription & Balance Chart Drain Output – Cumulative total for each fluid  Cumulative totals to be calculated for  each type of fluid 35

May 2013 – V0.7 Paediatric Fluid Prescription & Balance Chart Drain Output – Cumulative total for each fluid  Cumulative totals to be calculated for  each type of fluid  can be totalled at the end of the day  giving totals for each type of fluid

May 2013 – V0.7 Paediatric Fluid Prescription & Balance Chart 12. Output – Hourly Cumulative totals  Cumulative totals to be calculated for  each hour  to get an Hourly amount out and then Grand Total out Drain

May 2013 – V0.7 Paediatric Fluid Prescription & Balance Chart Drain Output – Hourly Cumulative totals  Cumulative totals to be calculated for  each hour  to get an Hourly amount out and then Grand Total out

May 2013 – V0.7 Paediatric Fluid Prescription & Balance Chart Record output totals with Day & Night totals if requested by Senior Staff

May 2013 – V0.7 Paediatric Fluid Prescription & Balance Chart 14. Calculate overall hourly balance 40  Calculate the overall balance  each hour

May 2013 – V0.7 Paediatric Fluid Prescription & Balance Chart Complete overall 24 hour balance These boxes must be completed on every patient with Day & Night totals if requested by Senior Staff

May 2013 – V0.7 Paediatric Fluid Prescription & Balance Chart Record Blood Glucose Record Blood Glucose when result available

May 2013 – V0.7 Paediatric Fluid Prescription & Balance Chart Record Signature Record signature or initials when making entries onto chart

May 2013 – V0.7 Paediatric Fluid Prescription & Balance Chart 18. Complete 12 hour assessment  Complete 12 hour assessment  Consider questions 44

May 2013 – V0.7 Paediatric Fluid Prescription & Balance Chart Start next day’s chart Front Back i. Labelling ii. Weight iii. Volumes

May 2013 – V0.7 Paediatric Fluid Prescription & Balance Chart 46 Fluid Prescription/Balance Chart