SFEBES2014 Poster Presentations Nursing practise (7 abstracts)
Hyponatraemia is associated with an increase in morbidity and mortality, prolonged hospital stays and poor assessment and management. Two audits were performed looking at acute medical unit (AMU) admissions with sodium <130 mmol/l, before and after the introduction of a protocol and regular endocrine nurse specialist ward visits, 3 months apart (58 patients in April and 99 in July 2013).
Hyponatraemic patients were older than the AMU population (>80 years: April 50%, July 46%, AMU 32%) and the length of stay was longer (9.12 days (D) (range 144) April (A); 10.57D (169) July (J); AMU 6.47D). The main four discharge specialties were Health Care For Older People, Endocrinology, Respiratory and Acute Medicine.
After the protocol, more patients with sodium <127 mmol/l had improvement at 24 h (April 65% were better, July 82%) and sodium was more frequently normal at discharge (19%A vs 28%J). Serum and urine osmolalities, TSH and cortisol were more frequently measured.
Monitoring for all patients with sodium <130 mmol/l was improved. Of the 41 notes examined in April and 74 in July, there were more fluid charts completed (49%A vs 64%J). Hyponatraemia was mentioned more frequently in the post take ward round (48%A vs 68%J) and fluid restriction more common (24%A vs 57%J). Assessment of fluid intake (43%A vs 20%J) and urinary sodium (19%A vs 22%J) remained poor, although not clinically relevant in all.
Only 19/58 patients had HRG codes for hyponatraemia in April and 26/99 in July (38/80 with Na <127 mmol/l). The additional income over 2 months for correct coding would have been £6540 (equivalent to £39240 per year).
Introduction of a protocol and endocrine specialist nurse involvement improves assessment of hyponatraemia, although urine sodium and assessment of fluid intake remains poor. These interventions highlight the issue of hyponatraemia at an early stage, leading to a focus on interventional management.