CLINICAL AUDIT: EQUINE INTRAVENOUS FLUID THERAPY
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FIGURE 4 The 2021 intensive care record sheet. Rows were divided into 1- h periods, one A4 sheet displayed a 12- h day. Parameters were recorded on the left (‘S’; subjective (demeanour), ‘T’: temperature, ‘P’: pulse, ‘R’: respiratory rate, ‘MM/CRT’: mucous membranes/ capillary refill time). In the ‘Faecal Output’, the number and consistency of droppings were noted when removed from the stable. The feeding
column was designed to monitor food intake by a simple symbol system. ‘G’: grass, ‘H’: hay, ‘HF’: hard feed, ‘H 2 O’: water. Ration amount and frequency would be noted in the box, and the symbol system would be used until ration volume/frequency was adjusted. A ‘tick’: all food was eaten, ‘~’: eating slowly, ‘X’: not eaten. The column labelled ‘Walkout Time’ allowed staff to insert how long the horse was removed from the stable. This column could be compared with the fluid graph when monitoring IVFT. The last two columns on the right allowed for medications, further observations, blood and ‘LAX’ nasogastric intubation to be recorded.
effective. However, performing the clinical audit quantified the ex- tent of the problem, which was surprisingly large. Upon review of the results of the first part of the audit, the major
obstacles identified contributing to deviations in fluid administration rate were:
• Record keeping; lack of recording or not recording as often as required.
• Accurately determining the volume of fluid remaining in the hang- ing fluids bags.
The existing ICU record sheets (Figure 1 ) had boxes for recording
when new fluid bags were hung (and the volume) and for recording the estimated quantity remaining in the hanging bags. This method of recording involved continuous calculation and was not user- friendly. The scatter graph (Figure 2 ) implemented during the audit, displays the volume ( y - axis) and time ( x - axis) over 12 h. The prescribed fluid
rate was drawn on the graph ahead of each 12- h period, and at each patient check the actual volume received was marked, providing a contemporaneous and visually simple to interpret record. A graph is efficient and user- friendly providing a quick representation of the volume the patient has received. The LOBF can be seen as a short- term goal for the user as they can see how much a patient should have received at a point in time and when they are due to finish. This can be compared to the ‘Goal- Setting Theory of Motivation’. Setting an attainable goal motivates people to develop strategies that will enable them to achieve that goal, which in turn improves perfor- mance, outcome and instils a feeling of accomplishment (Locke & Latham, 2002 ). Additionally, the ICU record sheets were modified (Figure 4 )
to allow a full 12- h day/night to be viewed on one side of the A4 paper. The plan, diagnostic tests, patient examination, medications, requirements and feeding plan can be updated by the hour. It al- lows the reader to easily and efficiently understand and document
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