Variability in the prescribing of intravenous fluids

A cross sectional multicentre analysis of clinical practice

G. Ramsay (Lead / Corresponding author), A. Baggaley, P. G. Vaughan Shaw, E. Soltanmohammadi, N. Ventham, Ng Guat Shi, R. Pearson, S. R. Knight, C. T. Forde, N. Moore, J. Kilkenny, K. D. Clement, M. Kumar, on behalf of the Scottish Surgical Research Group

Research output: Contribution to journalArticle

Abstract

Aims: Intravenous (IV) fluid administration continues to be a mainstay of care in General Surgery. Yet if they are prescribed incorrectly significant morbidity including electrolyte abnormalities, renal impairment and cardiac failure can develop. Despite this, it is frequently the responsibility of the most junior staff to prescribe IV fluids. We aim to analyse the understanding of IV fluid prescribing amongst junior doctors and to describe variability in clinical practice.

Methods: We undertook a multicentre questionnaire study. Foundation doctors and specialty trainees were invited to undertake a two part paper-based questionnaire. Part one analysed baseline knowledge of the concentration of commonly prescribed fluids. Part two consisted of four clinical vignettes requiring a IV fluid prescribing decision by the surveyed doctor.

Results: A total of 143 Doctors working in 8 hospitals were recruited. 65 (45.5%) doctors correctly stated the daily maintenance fluid requirements of water for an adult (25-30 mls/kg/day), while only 54 (37.8%) knew the sodium concentration of 0.9% NaCl. Lack of postgraduate experience (p = 0.011), qualifying from a medical school outside the United Kingdom (p < 0.0001) and working in one of the eight hospitals in this study (p < 0.0001) were associated with a lower knowledge level. There was limited consensus in prescribing in the responses to the 4 clinical scenarios, with 69 unique combinations of fluid choice, rate and volume prescribed.

Conclusions: Knowledge of the constituents of common IV fluids and routine requirement for fluid and common electrolytes is poor across junior doctors of all grades, driving large variation in clinical practice.

Original languageEnglish
Pages (from-to)199-204
Number of pages6
JournalInternational Journal of Surgery
Volume51
Early online date31 Jan 2018
DOIs
Publication statusPublished - Mar 2018

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Electrolytes
Cross-Sectional Studies
Medical Schools
Intravenous Administration
Multicenter Studies
Renal Insufficiency
Heart Failure
Sodium
Maintenance
Morbidity
Water
Surveys and Questionnaires
United Kingdom

Keywords

  • Education
  • Intravenous fluids
  • Patient safety
  • Post operative management
  • Quality assurance

Cite this

Ramsay, G., Baggaley, A., Vaughan Shaw, P. G., Soltanmohammadi, E., Ventham, N., Guat Shi, N., ... on behalf of the Scottish Surgical Research Group (2018). Variability in the prescribing of intravenous fluids: A cross sectional multicentre analysis of clinical practice. International Journal of Surgery , 51, 199-204. https://doi.org/10.1016/j.ijsu.2018.01.034
Ramsay, G. ; Baggaley, A. ; Vaughan Shaw, P. G. ; Soltanmohammadi, E. ; Ventham, N. ; Guat Shi, Ng ; Pearson, R. ; Knight, S. R. ; Forde, C. T. ; Moore, N. ; Kilkenny, J. ; Clement, K. D. ; Kumar, M. ; on behalf of the Scottish Surgical Research Group. / Variability in the prescribing of intravenous fluids : A cross sectional multicentre analysis of clinical practice. In: International Journal of Surgery . 2018 ; Vol. 51. pp. 199-204.
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title = "Variability in the prescribing of intravenous fluids: A cross sectional multicentre analysis of clinical practice",
abstract = "Aims: Intravenous (IV) fluid administration continues to be a mainstay of care in General Surgery. Yet if they are prescribed incorrectly significant morbidity including electrolyte abnormalities, renal impairment and cardiac failure can develop. Despite this, it is frequently the responsibility of the most junior staff to prescribe IV fluids. We aim to analyse the understanding of IV fluid prescribing amongst junior doctors and to describe variability in clinical practice.Methods: We undertook a multicentre questionnaire study. Foundation doctors and specialty trainees were invited to undertake a two part paper-based questionnaire. Part one analysed baseline knowledge of the concentration of commonly prescribed fluids. Part two consisted of four clinical vignettes requiring a IV fluid prescribing decision by the surveyed doctor.Results: A total of 143 Doctors working in 8 hospitals were recruited. 65 (45.5{\%}) doctors correctly stated the daily maintenance fluid requirements of water for an adult (25-30 mls/kg/day), while only 54 (37.8{\%}) knew the sodium concentration of 0.9{\%} NaCl. Lack of postgraduate experience (p = 0.011), qualifying from a medical school outside the United Kingdom (p < 0.0001) and working in one of the eight hospitals in this study (p < 0.0001) were associated with a lower knowledge level. There was limited consensus in prescribing in the responses to the 4 clinical scenarios, with 69 unique combinations of fluid choice, rate and volume prescribed.Conclusions: Knowledge of the constituents of common IV fluids and routine requirement for fluid and common electrolytes is poor across junior doctors of all grades, driving large variation in clinical practice.",
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Ramsay, G, Baggaley, A, Vaughan Shaw, PG, Soltanmohammadi, E, Ventham, N, Guat Shi, N, Pearson, R, Knight, SR, Forde, CT, Moore, N, Kilkenny, J, Clement, KD, Kumar, M & on behalf of the Scottish Surgical Research Group 2018, 'Variability in the prescribing of intravenous fluids: A cross sectional multicentre analysis of clinical practice', International Journal of Surgery , vol. 51, pp. 199-204. https://doi.org/10.1016/j.ijsu.2018.01.034

Variability in the prescribing of intravenous fluids : A cross sectional multicentre analysis of clinical practice. / Ramsay, G. (Lead / Corresponding author); Baggaley, A.; Vaughan Shaw, P. G.; Soltanmohammadi, E.; Ventham, N.; Guat Shi, Ng; Pearson, R.; Knight, S. R.; Forde, C. T.; Moore, N.; Kilkenny, J.; Clement, K. D.; Kumar, M.; on behalf of the Scottish Surgical Research Group.

In: International Journal of Surgery , Vol. 51, 03.2018, p. 199-204.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Variability in the prescribing of intravenous fluids

T2 - A cross sectional multicentre analysis of clinical practice

AU - Ramsay, G.

AU - Baggaley, A.

AU - Vaughan Shaw, P. G.

AU - Soltanmohammadi, E.

AU - Ventham, N.

AU - Guat Shi, Ng

AU - Pearson, R.

AU - Knight, S. R.

AU - Forde, C. T.

AU - Moore, N.

AU - Kilkenny, J.

AU - Clement, K. D.

AU - Kumar, M.

AU - on behalf of the Scottish Surgical Research Group

N1 - No Funding Received.

PY - 2018/3

Y1 - 2018/3

N2 - Aims: Intravenous (IV) fluid administration continues to be a mainstay of care in General Surgery. Yet if they are prescribed incorrectly significant morbidity including electrolyte abnormalities, renal impairment and cardiac failure can develop. Despite this, it is frequently the responsibility of the most junior staff to prescribe IV fluids. We aim to analyse the understanding of IV fluid prescribing amongst junior doctors and to describe variability in clinical practice.Methods: We undertook a multicentre questionnaire study. Foundation doctors and specialty trainees were invited to undertake a two part paper-based questionnaire. Part one analysed baseline knowledge of the concentration of commonly prescribed fluids. Part two consisted of four clinical vignettes requiring a IV fluid prescribing decision by the surveyed doctor.Results: A total of 143 Doctors working in 8 hospitals were recruited. 65 (45.5%) doctors correctly stated the daily maintenance fluid requirements of water for an adult (25-30 mls/kg/day), while only 54 (37.8%) knew the sodium concentration of 0.9% NaCl. Lack of postgraduate experience (p = 0.011), qualifying from a medical school outside the United Kingdom (p < 0.0001) and working in one of the eight hospitals in this study (p < 0.0001) were associated with a lower knowledge level. There was limited consensus in prescribing in the responses to the 4 clinical scenarios, with 69 unique combinations of fluid choice, rate and volume prescribed.Conclusions: Knowledge of the constituents of common IV fluids and routine requirement for fluid and common electrolytes is poor across junior doctors of all grades, driving large variation in clinical practice.

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KW - Education

KW - Intravenous fluids

KW - Patient safety

KW - Post operative management

KW - Quality assurance

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