Dear Colleagues, We continue to struggle with fluid boluses at my institutions. The general consensus is that patients are probably getting more fluid then what is being documented, but if nothing is documented, it is marked as a NO. We also still see a lot of 250-500cc boluses being given and repeated over several hours. Especially for patients that are out on the floor and develop hypotension but still 'look good'. I am looking for any suggestions or words of wisdom on how to improve not only the documentation, but the reluctance to 'go all in' and give the full weight based bolus. The literature supports it, and I see it in practice every day, how much better the patients that are adequately resuscitated do, versus the ones that are sort of 'watched'. It's just hard to really paint that picture in the data versus doing an actual case review. I know some institutions do an 'Atta boy' letter on patients that received the protocol...maybe that is the way to go! Time to do it, is really my only concern with that.
The second issue is how to achieve a high reliability that the protocol will be used and followed EVERY time. The same practitioners will sometimes do great and other times drag their feet..... I can't seem to put my finger on what it is or how to change it, so that it becomes second nature to do the same thing every time. Any thoughts? Thank you for allowing me to 'vent' and as always I look forward to your much valued opinions and thoughts! Claudia :) Claudia Orth, BSN, RN Sepsis Coordinator Munson Medical Center 1105 Sixth Street, Traverse City, MI 49684-2386 [email protected]<mailto:[email protected]> 231-935-5692 PLEASE NOTE: The information contained in this electronic mail message is a Patient Safety Work Product for Quality Improvement & Peer Review - This Information is Privileged and Confidential and intended only for certain recipients. If you are not an intended recipient, you are hereby notified that any disclosure, reproduction, distribution or other use of this communication and any attachments is strictly prohibited. If you have received this communication in error, please notify the sender by reply transmission and delete the message without copying or disclosing it.
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