Article Text

Download PDFPDF

P-132 Administration of subcutaneous fluids in the community setting; a quality improvement project
  1. Joy Ross1,
  2. Stefan Rakowicz2,
  3. Eva Trowers1,
  4. Amrit Aujla2,
  5. Amanda Rees3 and
  6. Emma Hall1
  1. 1St Christopher’s Hospice, London, UK
  2. 2Bromleag Care Practice, Bromley, UK
  3. 3Bromley Clinical Commissioning Group, Bromley, UK


Aim To identify patients suitable for subcutaneous fluid administration (SCF) in the home/care home setting and standardise clinical approach to assessment, decision making and evaluation of response.

Methods A standardised decision support tool was developed which supported bedside assessments. Patient/carer information leaflets were given and documentation of discussions/outcomes recorded in relevant clinical records (EMIS or SystmOne). We evaluated clinical response over three days: symptoms, side-effects/complications, observations or bloods and collated case vignettes.

Results Between April 2020-Feb 2021, 28 patients were assessed, median age 87.5(43-97) years, 20(71%) female. Place of care: 13(46%) own home, the remaining 15 (54%) resided in care homes/extra care housing. Diagnoses: 19 dementia; 6 cancer, 2 heart failure, 1 Motor Neurone Disease. Frailty scores (Rockwood): median 7(6-9).

17(61%) received SCF. Equipment was sourced equally from hospice and local pharmacy. Four had clear benefit, symptom relief, admission avoidance, alive >1mth post-intervention. Six cases demonstrated psychological benefit for patient/family with no harm/side-effects (all died 4-17 days post-intervention). Two had possible benefit but diuretics were withheld/reduced concurrently (1 alive >1mth post intervention, 1 died 3wks).

Five had no clear benefit, but no harm. 6/11 cases where SCF were not given, died within a week (2-8 days). Five with dementia in care home/extra-care housing were managed with mouthcare/encouraging oral fluids (3 alive >1month post-assessment).

Fluids were stopped due to side effects in three patients: none experienced ongoing harm. Volumes of fluid given varied. Feedback from clinicians and families suggested the tool facilitated discussion/understanding of rationale for giving/withholding.

Conclusion SCF was of clinical benefit for some patients, with minimal harm. The tool increased clinicians’ confidence to assess benefits/harms of SCF and address family concerns in a structured way. Further robust data collection is needed to monitor use/outcomes of SCF in a community setting and to better identify patients who may benefit.

Statistics from

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.