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

2. 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.

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

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

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

6. 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

7. 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

8. 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.

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

10. 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

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

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

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

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

15. 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

16. 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

17. 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 12.30 Hartmann’s Solution M

18. 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

19. 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

20. 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

21. 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

22. May 2013 – V0.7 Paediatric Fluid Prescription & Balance Chart 22 4. 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 1700 0.9% Sodium Chloride 20 mls/hr Xxxx. Xxxxx 10 mmol KCl Example 1: Based on 25 kg child. Example 1: Based on 25 kg child.

23. May 2013 – V0.7 Paediatric Fluid Prescription & Balance Chart 23 4. 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 1700 0.9% Sodium Chloride 20 mls/hr Xxxx. Xxxxx10 mmol KCl

24. May 2013 – V0.7 Paediatric Fluid Prescription & Balance Chart 24 4. Prescribe fluids Hartmann’s Solution 0.45%Sod. Chl. + 2.5% Glucose 0.9% Sodium Chloride Infusion fluids can also be identified by their Letter A B C

25. May 2013 – V0.7 Paediatric Fluid Prescription & Balance Chart 25 5. 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 1700 0.9% Sodium Chloride 20 mls/hr Xxxx. Xxxxx10 mmol KCl - including Batch number & Expiry date Infusion pump details Check

26. 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

27. 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 20 50 Hartmann’s 20 0.45% Sod Chl + 2.5% Glucose 50 0.9% Sodium Chloride

28. 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 20 50 20 50 * = identify with letter if wish * B D C Ensure

29. May 2013 – V0.7 Paediatric Fluid Prescription & Balance Chart 29 20G Right hand 20G Left ACF NG tube 20 50 20 50 7. Intake – Cumulative total for each fluid  Cumulative totals for  each type of fluid B D C Ensure

30. May 2013 – V0.7 Paediatric Fluid Prescription & Balance Chart 30 20G Right hand 20G Left ACF NG tube 20 50 20 50 7. Intake – Cumulative total for each fluid  Cumulative totals for  each type of fluid B D C 20 40 60 80 100 220 140 180 160 200 120 50 100 150 200 250 270 290 310 330 350 510 370 390 410 430 450 470 490 530 50 100 150 200 250 220 530250  can be totalled at the end of the day  giving totals for each type of fluid Ensure

31. May 2013 – V0.7 Paediatric Fluid Prescription & Balance Chart 31 20G Right hand 20G Left ACF NG tube 20 50 20 50 8. Intake – Hourly cumulative totals B D C 20 40 60 80 100 220 140 180 160 200 120 50 100 150 200 250 270 290 310 330 350 510 370 390 410 430 450 470 490 530 50 100 150 200 250  Cumulative totals to be calculated  each hour  to get an Hourly amount in and then Grand Total in 220 530250 Ensure

32. May 2013 – V0.7 Paediatric Fluid Prescription & Balance Chart 32 20G Right hand 20G Left ACF NG tube 20 50 20 50 B D C 20 40 60 80 100 220 140 180 160 200 120 50 100 150 200 250 270 290 310 330 350 510 370 390 410 430 450 470 490 530 50 100 150 200 250  Worked example 2.  With cumulative totalling of Each hour And Each fluid 490 580 650 720 110 180 250 320 390 40 20 410 450 790 860 900 920 940 980 880 960 1000 40 90 70 20 40 70 20 8. Intake 220 530 250 Ensure

33. May 2013 – V0.7 Paediatric Fluid Prescription & Balance Chart 33 9. Record intake totals 780 220 1000 200 290490 20 with Day & Night totals if requested by Senior Staff

34. May 2013 – V0.7 Paediatric Fluid Prescription & Balance Chart 10. Record outputs  Record  Site if necessary  Amount  Type  for each type of fluid. 34 15 5 25 40 50 5 60 10 20 Drain 1 50 60 25 100 25 20 30 20 5 0 100 75 100 50

35. May 2013 – V0.7 Paediatric Fluid Prescription & Balance Chart 15 5 25 40 50 5 60 10 20 Drain 1 50 60 25 100 25 20 30 20 5 0 100 75 100 50 11. Output – Cumulative total for each fluid  Cumulative totals to be calculated for  each type of fluid 35

36. May 2013 – V0.7 Paediatric Fluid Prescription & Balance Chart 15 5 25 40 50 5 60 10 20 Drain 1 50 60 25 100 25 20 30 20 5 0 100 75 100 50 11. Output – Cumulative total for each fluid  Cumulative totals to be calculated for  each type of fluid 36 20 95 75 45 100 95 40 35 30 145 105 80 55 255 195 305 50 110 210 235 655 380 455 555 20  can be totalled at the end of the day  giving totals for each type of fluid 655 100235

37. 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 37 15 5 25 40 50 5 60 10 20 Drain 1 50 60 25 100 25 20 30 20 5 0 100 75 100 50 20 95 75 45 100 95 40 35 30 145 105 80 55 255 195 305 50 110 210 235 655 380 455 555 20 655 100235

38. May 2013 – V0.7 Paediatric Fluid Prescription & Balance Chart 15 5 25 40 50 5 60 10 20 Drain 1 50 60 25 100 25 20 30 20 5 0 100 75 100 50 20 95 75 45 100 95 40 35 30 145 105 80 55 255 195 305 50 110 210 235 655 380 455 555 20 12. Output – Hourly Cumulative totals  Cumulative totals to be calculated for  each hour  to get an Hourly amount out and then Grand Total out 38 20 100 105 110 125 175 200 240 350 440 585 990 890 760 490 565 885 20 80 5 5 15 50 25 40 110 90 100 5 175 50 75 125 20 655 100235

39. May 2013 – V0.7 Paediatric Fluid Prescription & Balance Chart 39 13. Record output totals 655 100 990 235 with Day & Night totals if requested by Senior Staff 380 7525 275 110 125

40. May 2013 – V0.7 Paediatric Fluid Prescription & Balance Chart 14. Calculate overall hourly balance 40  Calculate the overall balance  each hour -20 -100 -85 -70 -15 5 50 80 40 -30 -40 -75 15 65 135 100 120 140 55 35 70 90 10 30 490 580 650 720 110 180 250 320 390 40 20 410 450 790 860 900 920 940 980 880 960 1000 40 90 70 20 40 70 20 100 105 110 125 175 200 240 350 440 585 990 890 760 490 565 885 20 80 5 5 15 50 25 40 110 90 100 5 175 50 75 125 20

41. May 2013 – V0.7 Paediatric Fluid Prescription & Balance Chart 41 15. Complete overall 24 hour balance These boxes must be completed on every patient. 655 100 990 235 380 7525 275 110 125 780 220 1000 200 290 490 20 +10 with Day & Night totals if requested by Senior Staff

42. May 2013 – V0.7 Paediatric Fluid Prescription & Balance Chart 42 16. Record Blood Glucose Record Blood Glucose when result available

43. May 2013 – V0.7 Paediatric Fluid Prescription & Balance Chart 43 17. Record Signature Record signature or initials when making entries onto chart

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

45. May 2013 – V0.7 Paediatric Fluid Prescription & Balance Chart 45 19. Start next day’s chart Front Back i. Labelling ii. Weight 1000 + 10 990 iii. Volumes

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