Problems with solutions: drowning in the brine of an inadequate knowledge base

Lobo, Dileep N.; Dubé, Myriam; Neal, Keith; Simpson, John; Rowlands, B. J.; Allison, S.P.

doi:10.1054/clnu.2000.0154

Cited by 120 publications

(123 citation statements)

References 6 publications

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“…Recommendations include training in fluid management, for medical and nursing staff, to increase awareness and spread good practice and that fluid management should be accorded the same status as drug prescription. A telephone survey has been used to assess the state of knowledge and fluid prescribing patterns among 200 junior doctors working in surgical wards in the UK (Lobo et al 2001a). It was found that in 89% of instances fluid prescribing is the responsibility of the most junior member of the team (the pre-registration house officer).…”

Section: Fluid and Electrolyte Prescriptions: Training And Practicementioning

confidence: 99%

Fluid, electrolytes and nutrition: physiological and clinical aspects

Lobo

2004

Proc. Nutr. Soc.

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Fluid and electrolyte balance is often poorly understood and inappropriate prescribing can cause increased post-operative morbidity and mortality. The efficiency of the physiological response to a salt or water deficit, developed through evolution, contrasts with the relatively inefficient mechanism for dealing with salt excess. Saline has a Na + :Cl -of 1 :1 and can produce hyperchloraemic acidosis, renal vasoconstriction and reduced glomerular filtration rate. In contrast, the more physiological Hartmann's solution with a Na + :Cl -of 1 . 18 :1 does not cause hyperchloraemia and Na excretion following infusion is more rapid. Salt and water overload causes not only peripheral and pulmonary oedema, but may also produce splanchnic oedema, resulting in ileus or acute intestinal failure. This overload may sometimes be an inevitable consequence of resuscitation, yet it may take 3 weeks to excrete this excess. It is important to avoid unnecessary additional overload by not prescribing excessive maintenance fluids after the need for resuscitation has passed. Most patients require 2-2 . 5 litres water and 60-100 mmol Na/d for maintenance in order to prevent a positive fluid balance. This requirement must not be confused with those for resuscitation of the hypovolaemic patient in whom the main aim of fluid therapy is repletion of the intravascular volume. Fluid and electrolyte balance is a vital component of the metabolic care of surgical and critically-ill patients, with important consequences for gastrointestinal function and hence nutrition. It is also of importance when prescribing artificial nutrition and should be given the same careful consideration as other nutritional and pharmacological needs.

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Section: Fluid and Electrolyte Prescriptions: Training And Practicementioning

confidence: 99%

Fluid, electrolytes and nutrition: physiological and clinical aspects

Lobo

2004

Proc. Nutr. Soc.

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“…Previous studies of junior medical staff have shown that pre-registration house officers (equivalent to foundation year one [FY1] doctors) were responsible for 89% of IV fluid prescribing. 16 In order to improve the process of IV fluid prescribing in hospital inpatients, our Trust, using a multi-disciplinary approach, developed and implemented a clinical guideline entitled Fluid Replacement Guideline for Adult Patients on Medical and Surgical Wards. This also incorporated advice from the British Consensus Guidelines on Intravenous Fluid Therapy for Adult Surgical Patients (GIFTASUP); 1 it did not incorporate all 28 GIFTASUP standards but attempted to incorporate those standards which we felt could lead to improved patient care and reduced morbidity from IV fluid use if appropriately followed.…”

Section: Introductionmentioning

confidence: 99%

Intravenous fluid use in the acutely unwell adult medical inpatient: improving practice through a clinical audit process

Walker

Stewart-Parker²,

Chinthapalli³

et al. 2012

J R Coll Physicians Edinb

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Background: Our Trust developed a clinical guideline to improve the prescribing and use of intravenous (IV) fluids based on the British consensus guidelines on IV fluid therapy for adult surgical patients. We audited the effect of targeted interventions to improve performance against this guideline. Method: There were 53 IV fluid prescription charts in the pre-intervention audit and 48 in the post-intervention audit. Data was collected on the seven local practice standards ('local gold standards') in the clinical guideline; compliance with all of them was necessary to meet the IV fluid prescribing bundle of care. Results: The proportion of prescriptions which met the IV fluid prescribing bundle of care increased (3.8% to 22.9% [p=0.004]) and the legibility of the IV fluid prescription increased (28.3% to 56.3% [p=0.004]). Conclusion:We have shown that the process of prescribing, administering and monitoring IV fluid use can be significantly improved through a range of targeted multi-disciplinary interventions.

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“…A telephone survey, 58 two prospective audits, 52,59 and a postal survey of 710 consultant surgeons 57 have confirmed that preregistration house officers (Foundation Year 1 doctors) are commonly made responsible for fluid prescription, but that less than half of them or their SHOs know even the sodium content of "normal" saline. Too few check fluid balance charts regularly, or appreciate for example the need for fluid replacement if bowel preparation is employed.…”

Section: Recommendation 14mentioning

confidence: 97%

Acute kidney injury in surgical patients

Kishen¹

2014

Anesthesia and Perioperative Care of the High-Risk Patient

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Problems with solutions: drowning in the brine of an inadequate knowledge base

Cited by 120 publications

References 6 publications

Fluid, electrolytes and nutrition: physiological and clinical aspects

Fluid, electrolytes and nutrition: physiological and clinical aspects

Intravenous fluid use in the acutely unwell adult medical inpatient: improving practice through a clinical audit process

Acute kidney injury in surgical patients

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