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American Academy of Pediatrics
Research Articles

Improving Isotonic Maintenance Intravenous Fluid Use at a Tertiary Children’s Hospital

Matthew Nordstrom, Geri Landman, Nora Pfaff and Sunitha V. Kaiser
Hospital Pediatrics April 2021, 11 (4) 374-379; DOI: https://doi.org/10.1542/hpeds.2020-003673
Matthew Nordstrom
aDepartments of Pediatrics and
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Geri Landman
bSutter East Bay Medical Group, Berkeley, California
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Nora Pfaff
aDepartments of Pediatrics and
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Sunitha V. Kaiser
aDepartments of Pediatrics and
cEpidemiology and Biostatistics and
dPhilip R. Lee Institute for Health Policy Studies, University of California San Francisco, San Francisco, California; and
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Abstract

OBJECTIVES: Maintenance intravenous fluids (IVFs) are routinely used in the care of hospitalized children. The American Academy of Pediatrics (AAP) published clinical practice guidelines in November 2018 that recommended the use of isotonic maintenance IVF. Our primary aim was to increase the proportion of hospital days pediatric inpatients were exclusively administered isotonic maintenance IVF to ≥80% by May 2020 at our institution.

METHODS: We conducted a single-center quality improvement (QI) study as part of an AAP collaborative. An interdisciplinary team led QI interventions including providing targeted education to clinicians, integrating guideline recommendations into the electronic medical record, engaging hospital leaders, and providing performance data to clinicians. Our study population included children ages 28 days to 18 years admitted to inpatient wards. Our primary outcome was the proportion of hospital days with exclusive isotonic maintenance IVF use. Balancing measures included transfers to the ICU, ordering of serum sodium laboratory tests, and adverse events. Data were analyzed by using statistical process control.

RESULTS: We analyzed 500 hospital admissions and found a significant increase in exclusive isotonic IVF use (63% to 95%) within 9 months of starting our QI intervention. We found no significant changes in balancing measures (serum sodium laboratory tests [24% to 25%], ICU transfer [0.3% to 1%], adverse events [0.3% to 1%]).

CONCLUSIONS: Our interdisciplinary QI team led interventions that were associated with significant improvements in isotonic IVF use, in accordance with AAP clinical practice guidelines. With our study, we provide detailed guidance on successful interventions for implementing this evidence-based guideline.

  • Copyright © 2021 by the American Academy of Pediatrics
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Hospital Pediatrics: 11 (4)
Hospital Pediatrics
Vol. 11, Issue 4
1 Apr 2021
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Improving Isotonic Maintenance Intravenous Fluid Use at a Tertiary Children’s Hospital
Matthew Nordstrom, Geri Landman, Nora Pfaff, Sunitha V. Kaiser
Hospital Pediatrics Apr 2021, 11 (4) 374-379; DOI: 10.1542/hpeds.2020-003673

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Improving Isotonic Maintenance Intravenous Fluid Use at a Tertiary Children’s Hospital
Matthew Nordstrom, Geri Landman, Nora Pfaff, Sunitha V. Kaiser
Hospital Pediatrics Apr 2021, 11 (4) 374-379; DOI: 10.1542/hpeds.2020-003673
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