Risk-lowering Strategy in Neonatal Intravenous Fluid (IVF) Therapy: An IV Fluid Calculator

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Abstract Summary
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Authors (including presenting author) :
Ngai VCY(1), Wong MSR(2), Wong SCM(2), Tam KFW(3), Lee WM(2), Law KCK(3), Kwan MTM(2), Yip YWC(1), Kong HS(1), Chui CMW(1), Wong SY(3)
Affiliation :
(1) Department of Pharmacy, Queen Mary Hospital (2) Department of Paediatrics and Adolescent Medicine, Queen Mary Hospital (3) Information Technology and Information System, Hong Kong West Cluster
Introduction :
Intravenous fluid (IVF) therapy is often needed by newborn babies in the Neonatal Unit. Fluid and electrolyte requirements are delicate for the neonatal population and often require meticulous calculations by physicians and pharmacists. Addition of electrolytes, such as potassium, is of high risk since too high a concentration or rate may cause extravasation or even arrhythmia. In the past, the prescription of IVF is done manually by physicians.
Objectives :
To invent and implement an online “IV Fluid Calculator”, aiming to: (1) Improve safety and minimize errors in IVF therapy in neonates (2) Standardize practice of IVF prescription in the Neonatal Unit of Queen Mary Hospital
Methodology :
In 2018, the Neonatal Team and Clinical Ward Pharmacist collaborated to design an “IV Fluid Calculator”. With support from the Information Technology and Information System (ITIS) Department, an online “Paediatric IV Fluid Clinical Calculator” was programmed. By entering the patient’s body weight, intended fluid and electrolytes requirements, an IVF prescription would be generated from the calculator. “Alert prompts” are also in place to alert the physician and pharmacist when the electrolyte concentration or rate of the IVF is too high. Print out of the “IV Fluid Calculator” can facilitate physicians’ prescribing in the Inpatient Medication Order Entry System (IPMOE) and subsequent verification by Clinical Pharmacists.
Result & Outcome :
The online “IV Fluid Calculator” was launched in the Hong Kong West Cluster Intranet in November, 2018. Currently, it is routinely used by paediatricians in the Neonatal Unit of Queen Mary Hospital. The “IV Fluid Calculator” is a product of multidisciplinary collaboration between physicians, Clinical Ward Pharmacist and the IT Department. With automatic calculation and alert prompting of concentration and rate of IVF, the risk of overdose and extravasation can hence be minimized.

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