intravenous fluid therapy guidelines€¦ · iv fluid therapy guidelines written by: dr james wood...

IV Fluid Therapy Guidelines Written by: Dr James Wood Review date: March 2018 RWF-OPG-PS15 Version no.: 1.1 of 18

Intravenous Fluid Therapy Guidelines

Requested/ Required by: NICE CG 174

Main author: Dr James Wood

Other contributors: Dr K Fai, Dr D Rutter

Document lead: Dr James Wood

Directorate: Critical Care

Specialty: Anaesthetics and Intensive Care Medicine

Supersedes: N/A – new document

Approved by: Drugs and Therapeutics Committee, December 2015

Ratified by: Clinical Guideline Ratification Group on behalf of Trust Clinical Governance Committee, 24th March 2016

Review date: March 2018

Disclaimer: Printed copies of this document may not be the most recent version. The master copy is held on Q-Pulse Document Management System

This copy – REV1.1


Document history

Requirement for document:

NICE clinical guideline 174

Cross references:

Associated documents:

Version control:

Issue: Description of changes: Date:

1.0 New guideline March 2016

1.1 Simple substitution of NEWS for PAR January 2019


Intravenous Fluid Therapy Guidelines Contents:

1.0 Introduction and scope

2.0 Definitions

3.0 Duties

4.0 Training / competency requirements

5.0 Procedure

6.0 Fluid management plan

7.0 Prescribing of IV fluids

8.0 Consequences of fluid mismanagement to be reported as clinical incidents

9.0 Monitoring and audit



Flowchart 1: From NICE Guidance CG174


1.0 Introduction and scope

The assessment and management of patients' fluid and electrolyte needs is fundamental to good patient care. However, the prescription of IV fluids is seldom simple or straight forward and carries with it significant risks associated with both over and under replacement. Fluid prescribing in clinical practice has frequently been shown to vary from best practice.

IV fluids are not all equivalent and should be considered akin to drugs, with each type of fluid having its indications, risks and benefits. The choice of IV fluid and the dosing regime for the IV fluid require careful assessment of the individual patient.

While it is vital that sick patients receive the right amount of the right fluid at the right time, in sick patients it is easy to give excess salt and water but very difficult to remove them. Fluid retention in sick patients with leaky capillaries contributes to complications such as ileus, nausea and vomiting, pressure sores, poor mobility, pulmonary oedema, and wound and anastomotic breakdown.

Interpretation of fluid requirements by reviewing blood results alone is also not straightforward, for example low serum sodium levels are commonly caused by excess water administration, not by inadequate sodium administration.

Traditional teaching on estimating IV fluid requirements on urine output have been shown to be incorrect. Urine output usually falls during illness or after trauma such as surgery because the kidney conserves both salt and water. Administration of excess IV fluid makes this worse resulting in cellular dysfunction and potassium loss. Administration of IV fluids can frequently result in hyperchloraemia (excess plasma chloride levels) leading to renal vasoconstriction and increased sodium and water retention. For these reasons urine output is often an unreliable guide to fluid requirements in sick patients and oliguria does not always require fluid therapy.

A number of recent studies have cast doubt on some established practices in this area, while some issued guidelines conflict with current teaching and practice.

These guidelines aim to provide simple guidance on:

Assessment of IV fluid requirements

Choosing appropriate IV fluid for a given situation

Monitoring the administration of IV fluid and electrolyte therapy

To help achieve those aims these guidelines cover:

Physiological principles that underpin fluid prescribing

Pathophysiological changes that affect fluid balance in disease states

Indications for IV fluid therapy

Reasons for the choice of the various fluids available

Principles of assessing fluid balance


Scope

The scope of these guidelines does not cover the practical aspects of administration (as opposed to the prescription) of IV fluids.

The target population for this guidance is all adult hospital inpatients who require IV fluid therapy to prevent or correct problems with their fluid and/or electrolyte status. The exclusions are:

Patients under 16 years

Pregnant women

Patients with severe liver disease

Patients with renal disease

Patients with diabetes

Patients with burns

Patients needing inotropes and those on invasive monitoring

Patients with traumatic brain injury (including patients needing neurosurgery)

2.0 Definitions

Us & Es: urea and electrolytes results

HB: haemoglobin

3.0 Duties

It is the duty of all clinical staff prescribing IV fluids to:

Assess the need for IV fluids, considering their risks and benefits

Identify the patients IV fluid requirements

Develop an IV fluid management plan for the patient including the monitoring of the patient

Reassess the patient thereafter at regular timely intervals

4.0 Training / competency requirements

All staff prescribing IV fluids should have received training to help them identify their patient’s fluid needs and to understand the risks and benefits of IV fluid administration. This should be formally reassessed at regular intervals to demonstrate competence in:

Understanding the physiology of fluid and electrolyte balance in patients with normal physiology and during illness

Assessing patients' fluid and electrolyte needs (the 5 Rs: Resuscitation, Routine maintenance, Replacement, Redistribution and Reassessment)

Assessing the risks and benefits of IV fluid administration

Prescribing and administering IV fluids

Evaluating, monitoring and documenting clinical changes in response to IV fluids and taking appropriate action as required

In addition all healthcare professionals should receive training and education to ensure their competence in, recognising, assessing and preventing the consequences of mismanaged IV fluid therapy such as:

Pulmonary oedema

Peripheral oedema

Volume depletion and shock


5.0 Procedure

The assessment and management of patients' fluid and electrolyte needs is fundamental to good patient care and should be undertaken as part of every ward review. IV fluid therapy should only be given to those patients whose needs cannot be met by the oral or enteral routes and should be stopped as soon as possible.

Skilled and competent healthcare professionals should prescribe and administer IV fluids, and assess and monitor patients receiving IV fluids. When prescribing IV fluids the health professional should ask themselves the following questions:

1. How is the patient, are they euvolaemic, hypovolaemic or hypervolaemic? 2. Does the patient need IV fluid? And if so why? 3. How much fluid do they require? 4. What type(s) of fluid does the patient need?

5.1 Question 1

How is the patient are they euvolaemic, hypovolaemic or hypervolaemic? This requires assessment of the patient’s fluid status, including:

Clinical examination of the patient and assessment of their respiratory rate, pulse, blood pressure, capillary refill, jugular venous pressure, presence of pulmonary or peripheral oedema, presence of postural hypotension and patient reported thirst.

Review of the patients clinical monitoring (NEWS Score), fluid balance chart and daily weights.

Review of current and recent fluid and drug prescriptions.

Review of recent laboratory investigations, current status and trends of full blood count, urea, creatinine and electrolytes.

Review of the patient’s history including any previous periods of limited intake and identification of patients who are malnourished and at risk of refeeding syndrome.

Review of the quantity and composition of abnormal losses.

Review of the patient comorbidities.

This should allow the clinician to ascertain whether the patient is:

Euvolaemic: veins are well filled, extremities are warm, blood pressure and heart rate are normal (depending on other pathology). These patients may require maintenance fluids.

Hypervolaemic: Patient is oedematous, may have inspiratory crackles; history of poor urine output or fluid overload.

Hypovolaemic: The patient may have cold hands and feet, absent veins, hypotension, tachycardia, oliguria and confusion. History of fluid loss or low intake. These patients may require fluid resuscitation.

If the patient is hypovolaemic, indicators that a patient may need urgent fluid resuscitation include:

Systolic blood pressure < 100 mmHg

Heart rate > 90 beats per minute

Capillary refill time > 2 seconds or cold peripheries

Respiratory rate > 20 breaths per minute


A patient’s probable response to fluid administration can be gauged at the bed side by use of passive leg raising. It is best undertaken with the patient initially semi-recumbent and then tilting the entire bed through 45°. Alternatively it can be by lying the patient flat and passively raising their legs to greater than 45°. If, at 30–90 seconds, the patient shows signs of haemodynamic improvement, it indicates that volume replacement may be required. If the condition of the patient deteriorates, in particular with breathlessness, it indicates that the patient may be fluid overloaded.

5.2 Question 2

Having ascertained the answer to the first question the second question can be approached i.e. Does the patient need IV fluid? And if so why?

If: The patient is euvolaemic or hypervolaemic, drinking adequately, receiving adequate fluid via nasogastric feed, parenteral nutrition (TPN), or large volumes of IV fluid as administered drugs, or a combination of these the patient probably does not require IV fluid administration.

If: The patient is not drinking or losing fluids they probably do require IV fluid administration.

If: the patient is hypovolaemic they probably will require IV fluid administration.

Why the patient needs IV fluids can then be addressed by considering 4 of the 5 Rs whether it is for:

Routine maintenance only: patient does not have excess losses above insensible loss. If no other intake they need approximately 30ml/kg/24hours. Remember to deduct from this any other fluids they may be receiving e.g. IV medication. Patients fasting for over 6 hours for any reason should be started on IV maintenance fluid. Delivery of routine maintenance IV fluids during daytime hours only should be considered in order to promote sleep and wellbeing.

Replacement of losses, e.g. GI secretions, blood (see picture 1) and Redistribution losses such as inflammatory losses, either previous or current. If losses are likely it is best to replace these later rather than give extra fluid in anticipation of losses which may not occur. This fluid replacement should be in addition to maintenance fluid.

Resuscitation: Patients who are hypovolaemic as a result of dehydration, blood loss or sepsis require urgent correction of intravascular volume depletion to correct the deficit. A baseline blood gas and measurement of the patient’s lactate levels may help delineate the severity of the patient’s hypovolaemia and inadequate perfusion.


5.3

Question 3 How much fluid do they require? can then be tackled.

Maintenance requirements can be calculated using the patients body weight. Maintenance fluid requirements can be estimated at 30ml/kg/24hour (Table 1). Reasonable adjustment should be made for specific patient populations such as the obese, frail, patients with cardiac impairment or failure, patients who are malnourished and at risk of re-feeding syndrome.

Review of recent Us &Es, other electrolytes and Hb as well as recent events e.g. fasting, fluid losses, sepsis, operations. Should be performed, in those patients with complicated pictures the patient’s fluid balance chart may provide useful information with regards to on-going losses.

Calculate or estimate any losses that need to be replaced. Which type of fluid has been lost, e.g. GI secretions, blood, inflammatory losses may help determine the fluid used for replacement. Inflammatory losses into the tissues are particularly hard to quantify and are common in pancreatitis, sepsis, burns and abdominal emergencies.


Urine does not need to be replaced unless it is being consistently lost in excessive volumes (i.e. > 1ml/kg/hour) (e.g. diabetes insipidus, recovering renal failure, and poorly managed diabetes mellitus). Post-operative patients will normally have a slightly reduced urine output due to appropriate anti-diuretic hormone release. High urine output in these patients may be due to excess fluid administration, they should therefore be assessed fully before any additional IV fluid therapy is prescribed.

5.4 Question 4 What type(s) of fluid does the patient need? can then be approached for each type of fluid requirement identified for the patient.

i) Maintenance fluid: See Algorithm 3: Routine maintenance. Maintenance IV fluid therapy should always be prescribed in ml/hr, and should always be given via a volumetric pump. Maintenance fluids should never be prescribed at a rate greater than 100ml/hour. Restrict the initial prescription to:

25–30 ml/kg/day of water

Approximately 1 mmo/kg/day of potassium, sodium and chloride

Approximately 50–100 g/day of glucose to limit starvation ketosis. (This quantity will not address patients' nutritional needs; see the NICE guideline Nutrition support in adults [NICE clinical guideline 32]).

Consider prescribing less fluid (for example, 20–25 ml/kg/day fluid) for patients who:

Are older or frail

Have renal impairment or cardiac failure

Are malnourished and at risk of refeeding syndrome (see the NICE guideline Nutrition support in adults [NICE clinical guideline 32]).

When prescribing for routine maintenance alone, consider using 25–30 ml/kg/ day sodium chloride 0.18% in 4% glucose with 20 mmol/l potassium on day 1 (there are other regimens to achieve this). Solutions such as 4%/0.18% dextrose/saline and 5% dextrose are important sources of free water for maintenance, but should be used with caution as excessive amounts may cause dangerous hyponatraemia, especially in children and the elderly. Prescribing more than 2.5 litres per day increases the risk of hyponatraemia. These are initial prescriptions and further prescriptions should be guided by monitoring and the fifth R: Re-assessment

For patients who are obese ideal body weight should be used to calculate their maintenance fluid requirements, seek expert help if their BMI is > 40 kg/m2.

Ideal body weight kg Fluid, ml/day Fluid, ml/hour

35-44 1200 50

45-54 1500 65

55-64 1800 75

65-74 2100 85

>75 2400 100 (max)

Table 1 - Maintenance fluid volumes and rates (simplified table from CG 174)


Sodium 1 mmol/kg/24hours (approx. 1 x 500ml 0.9%NaCl)

Potassium 1 mmol/kg/24hours (give 20mmol in each bag)

Glucose 1g/kg/24hours to minimize starvation ketosis (1L 4% glucose contains 40g; 1L 5% contains 50g)

Table 2 - Maintenance electrolyte requirements (from CG 174)

For patients with renal failure consult a senior doctor for fluid advice. If the serum potassium is above 5mmol/l or rising quickly do not give potassium containing fluids and consult hyperkalaemia policy for further advice. Magnesium, calcium and phosphate may fall in sick patients and so should be monitored and replaced as required as part of the patients Re-assessment.

ii) Replacement fluid: Replacement fluids are used to replace on-going fluid and electrolyte losses existing fluid and/or electrolyte deficits (or excesses) by adjusting (adding to or subtracting from) maintenance requirements, e.g. diarrhoea, vomit, drain outputs, bile, stoma outputs, blood losses (approximate electrolyte constituents of bodily fluids are given in Table 3) . See Algorithm 4: Replacement.

It is vital to replace large gastro-intestinal (GI) losses. Patients may otherwise develop severe metabolic derangement with acidosis or alkalosis and hypokalaemia. Hypochloraemia can occur with upper GI losses.

Fluid Na K Cl Normal vol/24h

Gastric fluid 50 15 140 2-3 litres

Bile 145 5 100 0.5-1 litres

Small bowel 140 11 70-130 varies

Ileostomy 50 4 25 0.5 litres

Colostomy 60 15 40 0.1-0.2 litres

Diarrhoea 30-140 30-70 - 0

Table 3 - Electrolyte content and volume of body fluids (mmol/l)

Urinary and insensible losses are met by the maintenance part of the prescription. In the recovery phase of acute kidney injury patients may start to pass more urine as they mobilise excess fluid which may require additional replacement fluids.

Hyponatraemia is common and in the absence of large GI fluid losses the causes are almost always excess fluid administration, SIADH, or chronic diuretic use.

A potassium value in the normal range does not necessarily mean that there is no total body potassium deficit. Potassium replacement: can be administered with 20 mmol KCl in 500ml 0.9%NaCl given at 125ml/hour. In critical care only up to 40mmol KCl can be administered in 100ml bags via a central line at 25ml/hour. Prior to administration of potassium containing fluids the IV access should be tested to ensure that it is working correctly as extravastation of potassium is harmful. Potassium-containing fluids must be given via a volumetric pump. For those patients able to receive it potassium supplementation may be given orally.

Replacement fluid volume requirements can be estimated by adding up all the losses over the previous 24 hours and this volume given as Hartmann’s (Compound Sodium Lactate) solution, or 0.9% NaCl with KCl as required.


Seek expert help if patients have a complex fluid and/or electrolyte redistribution issue or imbalance, or significant comorbidity, for example:

Gross oedema

Severe sepsis

Hyponatraemia or hypernatraemia

Renal, liver and/or cardiac impairment

Post-operative fluid retention and redistribution

Malnourished and refeeding issues

Replacement fluids should be given in addition to the calculated maintenance requirement.

iii) Resuscitation fluid: Requirements are best assessed by continuous reassessment at the bedside of patient status and vital signs in response to fluid challenges. This should initially be with crystalloid fluid challenges using crystalloids that contain sodium in the range 130–154 mmol/l, with a bolus of 500 ml over less than 15 minutes. Because of the risk of inducing hyperchloraemic acidosis in routine practice, when crystalloid resuscitation or replacement is indicated, balanced salt solutions, e.g. Ringer’s lactate/acetate or Hartmann’s solution, should be used in preference to 0.9% saline, except in cases of hypochloraemia, e.g. from vomiting or gastric drainage. In patients with known cardiac failure or cardiogenic shock this volume can be reduced (e.g. 250ml). Following the fluid challenge a repeat ABCDE assessment with review of vital signs and observations should be performed looking for improvement. See Algorithm 2: Fluid resuscitation

If patients are receiving IV fluids for resuscitation, reassessment should follow the ABCDE approach (Airway, Breathing, Circulation, Disability, Exposure) with regular monitoring of their respiratory rate, pulse, blood pressure and perfusion (at least every 15minutes initially) and regular measurement of their venous or arterial blood gases with assessment of their lactate and or pH and base excess according to guidance on advanced life support (Resuscitation Council [UK], 2011).

For patients with obvious and or on-going blood loss early consideration should be given to blood and clotting factor administration as per the major haemorrhage protocols. While starch based fluids for fluid resuscitation should be avoided consideration can be given to the use of human albumin solution or gelatin based fluids in patients who are repeatedly transiently responding to crystalloid fluid challenges.


6.0 Fluid management plan

Having answered the 4 questions an IV fluid management plan should be established and documented in the patient’s notes. This should include: Situation: This should include the answers to question 1, i.e. How is the patient? Are they euvolaemic, hypovolaemic or hypervolaemic? Background: This should be the answer to question 2, i.e. Why they need IV fluid? Assessment: This should be the answer to questions 3 and 4, i.e. How much fluid do they require? And what type(s) of fluid does the patient need? Recommendations: should include details of:

The fluid and electrolyte prescription over the next 24 hours

The assessment and monitoring plan with frequency requirements for clinical observations, and patient reassessment

If and when further blood gases should be taken and when the fluid management plan should be reviewed

Initially, the IV fluid management plan should be reviewed at least daily with review of clinical fluid status, laboratory values including urea, creatinine and electrolytes, fluid balance charts. IV fluid management plans for patients on longer-term IV fluid therapy whose condition is stable may be reviewed less frequently. Regular weight measurement ideally twice weekly is a useful adjunct to these assessments.

Be aware that:

Patients receiving IV fluid therapy to address replacement or redistribution problems may need more frequent monitoring.

Additional monitoring of urinary sodium may be helpful in patients with high-volume gastrointestinal losses. (Reduced urinary sodium excretion [less than 30 mmol/l] may indicate total body sodium depletion even if plasma sodium levels are normal. Urinary sodium may also indicate the cause of hyponatraemia, and guide the achievement of a negative sodium balance in patients with oedema. However, urinary sodium values may be misleading in the presence of renal impairment or diuretic therapy.)

Patients on longer-term IV fluid therapy whose condition is stable may be monitored less frequently, although decisions to reduce monitoring frequency should be detailed in their IV fluid management plan.

Patients receiving IV fluids containing chloride concentrations greater than 120 mmol/l (i.e. sodium chloride 0.9%) should have their serum chloride concentration monitored daily. Development of hyperchloraemia or acidaemia should prompt review of their IV fluid prescription and assess their acid–base status.

When prescribing IV fluids and electrolytes all other sources of fluid and electrolyte intake, including oral or enteral intake, intake from drugs, IV nutrition, blood and blood product administration should be taken into account.

Patients have a valuable contribution to make to their fluid balance. If a patient needs IV fluids, explain the decision, and discuss the signs and symptoms they need to look out for if their fluid balance needs adjusting. If possible or when asked, provide written information (for example, NICE's Information for the public [see the "Patient Resources" field]), and involve the patient's family members or carers (as appropriate).

Reassessment of fluid status and IV fluid management plans should occur upon arrival in new clinical settings for patients who are transferred or in response to clinical deterioration. Expert help should be sought if patients have a complex fluid and/or electrolyte redistribution issue or imbalance, or significant comorbidity.


7.0 Prescribing of IV fluids When prescribing IV fluids the 5 Rs should be remembered: Resuscitation, Routine maintenance, Replacement, Redistribution Reassessment.

All IV fluid prescriptions should include the following information:

The type of fluid to be administered

The rate and volume of fluid to be administered

8.0 Consequences of fluid mismanagement to be reported as clinical incidents

Clear incidents of fluid mismanagement (for example, unnecessarily prolonged dehydration or inadvertent fluid overload due to IV fluid therapy) should be reported through standard clinical incident reporting (DATIX) to encourage improved training and practice (see table below).

Consequence of fluid mismanagement

Identifying features Time frame of identification

Hypovolaemia Patient's fluid needs not met by oral, enteral or IV intake and

Features of dehydration on clinical examination

Low urine output or concentrated urine

Biochemical indicators, such as more than 50% increase in urea or creatinine with no other identifiable cause

Before and during IV fluid therapy

Pulmonary oedema (breathlessness during infusion)

No other obvious cause identified (for example, pneumonia, pulmonary embolus or asthma)

Features of pulmonary oedema on clinical examination

Features of pulmonary oedema on X-ray

During IV fluid therapy or within 6 hours of stopping IV fluids

Hyponatraemia Serum sodium less than 130 mmol/l

No other likely cause of hyponatraemia identified


Hypernatraemia Serum sodium 155 mmol/l or more

Baseline sodium normal or low

IV fluid regimen included 0.9% sodium chloride

No other likely cause of hypernatraemia identified



Consequence of fluid mismanagement

Identifying features Time frame of identification

Peripheral oedema Pitting oedema in extremities and/or lumbar sacral area

No other obvious cause identified (for example, nephrotic syndrome or known cardiac failure)


Hyperkalaemia Serum potassium more than 5.5 mmol/l

No other obvious cause identified


Hypokalaemia Serum potassium less than 3.0 mmol/l likely to be due to infusion of fluids without adequate potassium provision

No other obvious cause (for example, potassium-wasting diuretics, refeeding syndrome)


This table was drafted based on the consensus decision of the members of the NICE Guideline Development Group


Trust-wide IV fluid management will be monitored by the Outreach Team performing an annual audit, where they will using the NICE audit tools:

Record all episodes of fluid mismanagement they identify and compare this with the recorded critical incidents related to fluid management over the same week

Identify the frequency with which adequate fluid management plans have been made in the patient records.


APPENDIX ONE Process requirements

1.0 Implementation and awareness

Once approved the document will be emailed to the Corporate Governance Assistant for activation on the Trust approved document management database (Q-Pulse) and will be accessible via search on the staff intranet.

Managers should ensure that their staff members are aware of new publications.

It is recommended that an e-learning package on fluid prescription for Trust doctors be developed.

2.0 Review

The guideline should be reviewed every two years and updated as required in the light of new evidence and guidelines.

3.0 Archiving

The Trust intranet retains all superseded files in an archive directory in order to maintain document history.


APPENDIX TWO CONSULTATION ON: IV Fluid Therapy Guidelines

Consultation process – Use this form to ensure your consultation has been adequate for the purpose.

Please return comments to: Dr James Wood at [email protected]_____________

By date: 14/11/2015

Job title: Date sent dd/mm/yy

Date reply received

Modification suggested?

Y/N

Modification made?

Y/N

The following staff MUST be included in ALL consultations:

Local Counter Fraud Specialist 14/10/15

Clinical Governance Assistant 08/04/16 21/04/16 Y Y

Chief Pharmacist (if pharmacy/prescribing issues are included in the document)

14/10/15

Please list other staff to be included in the consultation but whose reply is not compulsory:

CD Medicine 14/10/15

CD Surgery 14/10/15

CD Critical Care 14/10/15

DTC Chair 14/10/15

MD 14/10/15

DN 14/10/15

Director of Infection Control 14/10/15

Audit & Research Manager 14/10/15

PDN ED 14/10/15 15/10/15 y y

Principal Pharmacist - Medication Safety and Safe Prescribing

18/1/16 18/1/16 y y

The following staff have consented for their names to appear in this and any associated documents:

Dr James Wood

Dr K Fai

Dr D Rutter

The role of those staff being consulted upon as above is to ensure that they have shared the policy for comments with all staff within their sphere of responsibility who would be able to contribute to the development of the policy.


APPENDIX THREE

Equality Impact Assessment

In line with race, disability and gender equalities legislation, public bodies like MTW are required to assess and consult on how their policies and practices affect different groups, and to monitor any possible negative impact on equality. The completion of the following Equality Impact Assessment grid is therefore mandatory and should be undertaken as part of the policy development and approval process. Please note that completion is mandatory for all policy development exercises. A copy of each Equality Impact Assessment must also be placed on the Trust’s intranet.

Title of policy or practice IV Fluid Therapy Guidelines

What are the aims of the policy or practice?

These guidelines aim to provide simple guidance on assessment of IV fluid requirements, choosing appropriate IV fluid for a given situation and monitoring the administration of IV fluid and electrolyte therapy

Identify the data and research used to assist the analysis and assessment

Analyse and assess the likely impact on equality or potential discrimination with each of the following groups.

Is there an adverse impact or potential discrimination (yes/no). If yes give details.

Males or Females No

People of different ages No People of different ethnic groups No People of different religious beliefs No People who do not speak English as a first language

No

People who have a physical disability No People who have a mental disability No Women who are pregnant or on maternity leave

No

Single parent families No People with different sexual orientations No People with different work patterns (part time, full time, job share, short term contractors, employed, unemployed)

No

People in deprived areas and people from different socio-economic groups

No

Asylum seekers and refugees No Prisoners and people confined to closed institutions, community offenders

No

Carers No If you identified potential discrimination is it minimal and justifiable and therefore does not require a stage 2 assessment?

When will you monitor and review your EqIA?

Alongside this policy/procedure when it is reviewed.

Where do you plan to publish the results of your Equality Impact Assessment?

As Appendix 3 of this policy/procedure on the Trust approved document management database on the

intranet, under ‘Policies & guidelines’.

intravenous fluid therapy guidelines€¦ · iv fluid therapy guidelines written by: dr james wood...

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