Introduction Patients with dehydration and electrolyte imbalance owing to high output ileostomy or malabsorption frequently require intravenous (IV) replacement therapy to maintain health (1). This patient cohort were at high risk of re-admission (average 5 days) with acute kidney injury (AKI), admission (average 2 days) for IV electrolyte replacement, or an extended inpatient stay awaiting timely surgery to reinstate bowel continuity. An outpatient review and blood monitoring service was fully established in 2016 by the Nutrition Support Team (NST) to guide day case IV fluid and electrolyte replacement. Project aims were to
1. Allow safe discharge of those patients reliant on frequent IV fluids and/or electrolytes.
2. Reduce the incidence of re-admission with AKI and deranged electrolytes.
Method The NST comprising of 1 consultant gastroenterologist, 1 consultant chemical pathologist, 2 dietitians, 2 pharmacists, and 1 specialist nutrition nurse identified patients at risk of dehydration and electrolyte imbalance. Risk factors included high output ileostomy or malabsorption. A nurse-led blood monitoring service was set up with day case attendance for IV fluid and electrolyte replacement as required. IV fluids and electrolytes were predominantly prescribed by the specialist nurse. The NST multidisciplinary team guided ongoing management of complex patients. Face-to-face follow up was achieved in parallel to day case attendance for IV replacement or at the NST outpatient clinic. Remote telephone clinics enhanced the follow up service.
Conclusion The NST outpatient blood monitoring service, with day case IV fluid and electrolyte replacement saves bed days and keeps patients at home. It allows at risk patients to avoid lengthy inpatient stay and readmission with AKI. The multidisciplinary NST delivers comprehensive management of a complex patient group. Independent nurse prescribing enhances the efficiency of the service.
. Pironi L, et al. (2016) ESPEN guidelines on chronic intestinal failure in adults, Clinical Nutrition35, 247–307
Disclosure of Interest None Declared
- independent nurse prescribing
- Intestinal failure
- nurse led