Intravenous Fluids: Do Doctors Know What They are Prescribing ?

Abstract

fluid prescription is an essential part of peri-operative care in surgical patients. This is usually left to the most junior trainees. Although knowledge of fluid prescription is part of the core curriculum in all undergraduate and most postgraduate exams, junior doctors may still lack sufficient knowledge and training to perform this competently. Prescription is therefore variable and often inappropriate.

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

“…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. 1,3,20 However, in medical practice, middle grade clinicians (eg SpRs) often 'direct' fluid management, which is subsequently 'written up' by junior colleagues.…”

“…20 In postoperative surgical patients, junior clinicians are responsible for >85% of fluid prescriptions. 1,3,20 However, in medical practice, middle grade clinicians (eg SpRs) often 'direct' fluid management, which is subsequently 'written up' by junior colleagues. In an 'apprenticeship-style' training system, like GIM, inadequate senior clinician 'knowledge' is likely to impact junior colleagues training.…”

“…Earlier this year, a similar study in FYs also reported an improvement in the knowledge of daily water/electrolyte requirements but not of fluid composition (only 31% knew the sodium content of 0.9% saline). 20 'Desirable' knowledge also improved compared to historical assessments, with most clinicians aware of the metabolic risks of excess saline. However, less than 50% knew the normal serum chloride or intracellular electrolyte concentrations.…”

Surgical Fluid Prescribing: When Are the Last Orders?

“…A survey of consultant surgeons in 2002 revealed that only 16% of respondents believed their pre-registration house officers were adequately trained and only 30% thought the fluids prescribed were adequate [8]. Subsequent studies have continued to show that FY1s have a poor knowledge base for fluid prescribing [9][10][11][12][13][14], with patients often given too much fluid with an excess of sodium and not enough potassium. Furthermore, fluid assessments are commonly performed without reference to the fluid balance or the latest biochemistry results [1,[14][15][16].…”

“…Previous studies have focused on the type and quantity of fluids prescribed and the implications they have on patient morbidity [1,15]. They have consistently recommended improvement in junior doctor education 1 1 [7,8,10,[12][13][14][15]], yet fluid prescriptions still remain highly variable [13,14]. This study explores the nature of fluid reviews during the out-of-hour periods (OOHs) to determine if additional improvements could be made by addressing how and when fluid reviews are requested.…”