Intravenous fluid prescribing practices by foundation year one doctors – a questionnaire study

Abstract

ObjectivesFoundation Year Ones (FY1s) are the most junior doctors in the UK who are often required to prescribe intravenous fluid to patients not under their regular care, during on-call or out-of-hours ward cover. This study aimed to investigate FY1s’ practice and decision-making process of intravenous fluid prescribing to these patients.DesignQuestionnaire survey.SettingSurvey on Practices during on-calls and out-of-hours ward covers.ParticipantsFY1s of five National Health Service (NHS) hospitals in England and Scotland.ResultsAll 149 FY1s responded to survey. Eighty-six percent have been taught intravenous fluid prescribing during medical school, compared with only 48% in FY1 induction. More than half always/often checked the patient's urea and electrolytes (U&Es) (72%), read the fluid balance (58%) and observation charts (80%), discussed the case with nursing staff (75%), enquired about oral status (82%), identified the main diagnosis/operation (75%) and indication for intravenous fluid (72%) of the patient when prescribing intravenous fluid. However, less than half often/always read the medical notes (43%) or performed clinical examinations on patients (16%). Most FY1s (94%) always/often checked patient's U&Es when prescribing potassium.ConclusionsThe questionnaire study demonstrated variations among FY1s in the practice and decision-making process of intravenous fluid prescribing to patients unknown to them, during on-calls or out-of-hours ward covers. Such variations in practice should be addressed especially by medical and foundation schools, and NHS hospitals to improve patient care.

American Society for Enhanced Recovery and Perioperative Quality Initiative Joint Consensus Statement on Postoperative Gastrointestinal Dysfunction Within an Enhanced Recovery Pathway for Elective Colorectal Surgery

“…While no specific data exists for this situation, certain principles of fluid management have been shown to correlate with patient benefit and harm. Additionally, recent research has noted a wide variability in the practice of fluid management by many trainees 106 ; thus, a structured, principle-based approach is needed, as both hypervolemia and hypovolemia throughout the perioperative period are associated with much worse outcomes for surgical patients. 71 First, euvolemia should be targeted and individualized to the patient such that patients are only given fluid boluses when there is a demonstrated need for augmentation of perfusion status and when they have been shown to be volume responsive.…”

Intravenous fluid selection rationales in acute clinical management

“…However, it was shown in various studies that clinicians were deficient in the knowledge of IVF. [5,12] Regarding the results obtained from part 3 of our study, there is still room for improvement in the adequacy of guideline, training and information provided on IVF prescription. A study in the United Kingdom surveyed impression of consultant surgeons about their junior staff in peri-operative fluid replacement also showed similar result.…”

“…Variations in IVF prescription practices also exist amongst clinicians. [4,5] To review the understanding of clinicians on various IVF and evaluate the adequacy of IVF guidelines and trainings in the New Territories West Cluster (NTWC) of Hong Kong, this study aimed at gaining an insight on the primary considerations in IVF prescriptions based on several acute clinical scenarios.…”

Fluid management knowledge in hospital physicians: ‘Greenshoots’ of improvement but still a cause for concern

“…3,14,15 The poor fluid management knowledge of junior clinicians is well documented and has remained a concern in recent studies. 6,[15][16][17][18][19] Surgical SpRs and consultants perform slightly better than their juniors but little is known about the knowledge of 'senior medical' clinicians. 20 In postoperative surgical patients, junior clinicians are responsible for >85% of fluid prescriptions.…”