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Module 3 : Prescribing

 

 

Practicalities of fluid prescribing

 

You will find a separate fluids prescribing section on almost every hospital drug chart, and it is usually on the back.

 

When you come to prescribe in this section, the chart will ask you to provide certain information. This will include:

 

What fluid?

What volume?

What rate?

What route?

Which additives to include?

 

Hopefully having read the rest of this module, you feel confident that you can answer all of these questions.

 

However, as this is a legal prescription there are also a number of other things you must do before you can give your prescribed fluid. You must:

 

  • Check the patient's name, date of birth and hospital number is correctly entered on the front of the drug chart. Often it must be re-written on the fluid prescribing sheet on the back also.
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  • Check the patient has no allergies. Again, this will be on the front of the chart and also often on the fluids section also. It is also important to check with the patient verbally if possible, and check for an allergy wristband.
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  • Provide any other information the chart requires. For example ward, bed number or consultant.
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    Once you have checked all of this information is accurate and you have correctly prescribed the fluids you must date and sign the prescription to make it legal. Most hospitals also require that you write in black ink. Once this has all been done you or the nursing staff may administer the fluid.

     

     

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    The image below shows the front of a typical drug card. These vary slightly between trusts.

     

    (Click on the image to enlarge)

     

     

    An example

     

    Below is an example of how you would write up the fluid regimen for the imaginary patient we discussed earlier: Miss Imaginary.

     

     

    Fluid regimen

     

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    The prescription

     

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    (click on the image to enlarge)

     

     

    Important notes

     

    by convention nursing staff will not start the next bag of fluid until the previous has finished. If you want to run two bags simultaneously write it on the chart and inform the nursing staff.

     

    There is a wide degree of acceptable variation as to the way the ‘rate’ is expressed. It may be written as a period of time over which the fluid is to be given (eg 8hrs as written on the drug chart) or as a volume per unit time (eg ml/min).

     

    The route is usually IV (intravenous) or IVI (intravenous infusion) but there are others, for example S/C (subcutaneous)

     

    Common additives are KCL or drugs such as antibiotics, although on many charts there is a separate place for these.

     

    This is a fairly simple prescription for maintenance fluids. Now move on to module 4: practice cases, to try your hand at some more complex scenarios.

     

     

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