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DODD and SMITH
FIGURE 1 The 2020 intensive care record sheet. Parameters were marked on the left, observations of the patient in the middle, when IVFT commenced, the number of bags hung would be marked under ‘New’ and the total number of bags hanging marked under ‘Total’. The preferred maintenance rate was noted under the ‘XM’ column, and the volume of fluid received/hanging would be noted in the ‘Due/Had’ column. Fluid received was calculated by totalling the volume from the ‘Had’ column in each time period. Any issues disturbing intravenous fluid delivery were to be written in the ‘Observations’ column.
Intravenous fluid administration protocol An
intravenous over- the- needle 14G Mila
made at regular time points throughout the day and night (typically every 3 h).
catheter (Mila
International) was placed into the jugular vein using the standard aseptic technique and secured with nylon sutures. Either two or four 5 L fluid bags were suspended from the ceiling of the stable and connected to the patient with a 1000 STAT large (International WIN Ltd.) bore giving set and large bore 7″ catheter extension (International WIN Ltd.). Horses were left free in the stable. Fluid rate was set at two to three drops per second (1 L/h) for mainte- nance rate, and for achieving twice maintenance the drip rate to a fast drip (four to six drops per second), where caregivers could only just count the drips. During the entire study period, weight was estimated at 500 kg
for all horses, due to the predominance of Thoroughbred horses in the hospital population. Maintenance fluid rate was set at 50 mL/ kg/day. Adjustments to flow rate were made based on comparing es-
timates of fluid volume remaining in the hung bags, with the pre- scribed amount that should have been administered. Estimates were
Review and creation of an improvement plan
After data were collected in 2020 and results were presented, an initial improvement plan was implemented 2 weeks after discussion and was refined from July 2020 to December 2020 before the final action plan was introduced in January 2021.
Improvements from 2020
• Modify the ICU records sheet to improve recording efficiency and efficacy (Figure 4 ).
• Produce a fluid plan scatter graph (Figure 2 ); an efficient visual representation of prescribed vs. actual fluid volume administered.
• Improve accuracy of recording fluid volume administered; during the initial audit period in 2020, volume of fluid administered was
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