This article in Today's Hospitalist,
drawn from recent talks at the UCSF hospitalist conference, has a lot
of pearls. Most of the admonitions are about avoiding knee jerk
care.
The real gem comes in her discussion of
the importance of de-escalation of IV fluids:
“Multiple studies have replicated that, even in sepsis,” Dr. Santhosh noted. “After initial resuscitation with early goal-directed therapy, you want a maintenance or stabilization phase and then de-escalation.” That could mean active diuresis in patients to attain a negative fluid balance once they’re off pressors.
And while it can be a challenge to find the maintenance fluids in your EHR to discontinue them…
That’s right. She said, in effect,
that the EHR interferes with the clinician’s ability to discontinue
potentially harmful IV fluids. The statement rings true and concerns
one of those key provisions of meaningful use: CPOE. Meaningful to
patients for sure if it interferes with their care with the potential
for harm.
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