The use of a patient group direction to ensure prompt treatment of postoperative hypotension in orthopaedic patients

Patients undergoing major orthopaedic surgery are at risk of developing postoperative hypotension. In the majority of cases this is secondary to hypovolaemia. In an attempt to ensure prompt treatment of such hypotension, a multidisciplinary group from the Chesterfield Royal Hospital worked together to produce a patient group direction (PGD), that would allow nurses to administer fluid boluses. This was piloted for 3 months on three orthopaedic wards. During the pilot period, the PGD was used 14 times. The average increase in systolic blood pressure following a fluid bolus was 18.7 mm Hg. Only one patient did not respond. None of the patients suffered complications as a result of the fluid bolus(es). Early indications are that this initiative appears to be a safe and effective way of empowering nurses to treat early signs of physiological deterioration. This PGD could be easily adapted for use in other surgical specialities.