Evidence-based Practice Proposal for the Institution of a Pre-hospital Hypotensive /Delayed Fluid Resuscitation Policy for Trauma Patients

Abstract

This paper details a proposal for the institution of a pre-hospital hypotensive/delayed intravenous (IV) fluid administration policy for trauma patients. The policy is necessitated by observed variations in current paramedic practices. It is also informed by a need for the utilisation of evidence-based practices in the pre-hospital settings. (Queensland Ambulance Services [QAS], 2016) the current policy on pre-hospital resuscitation recommends IV fluid resuscitation for patients with hypovolaemia secondary to trauma-related bleeding. This policy, however, fails to provide guidance on the setting, timing, and quantity of fluid to be administered. Additionally, it is based on theoretical rationalisations for the need to correct hypotension as opposed to empirical evidence. As such, a change in practice is necessary to ensure that current paramedic practices conform to evidence-based practice and trauma patients receive quality and timely pre-hospital care. The proposal will be structured in sections. The first section is a literature review of available literature on the best practices for pre-hospital IV fluid resuscitation in trauma patients. It will lay a foundation for the subsequent sections. The second section presents a critical analysis of the literature review. The third section describes the six-sigma model and the rationale for its use in the implementation of the proposed change. The fourth section is an outline of the systematic plan for overcoming potential barriers to the proposed quality improvement initiative.