EP.TU.364Intravenous fluid prescribing – common pitfalls and suggestions for improvement

Aim Intravenous fluids are no doubt most prescribed treatments in surgical practice. It is also an area where junior doctors’ performance is commonly found deficient. There appeared to be a gap in general knowledge of fluid and electrolyte management. Our audit aims to assess the competency of surgical juniors in fluid prescribing as compared to recommendations set out by GIFTASUP 2011. FY1s have also been asked to complete a survey on fluid and electrolyte management. Method We included all adult surgical inpatients (28) admitted over one week to our DGH who were started on IV fluids for maintenance only. We retrospectively audited their prescription charts and medical notes. FY1's in the department have been also asked to fill out a short survey testing their knowledge on fluid and electrolyte requirements. Following this, we held a tutorial on fluid management of surgical inpatients for FY1's. We also made fluid management algorithm available in SAU for reference. Results Data was tabulated and outcomes compared with CG174 guidance. Cycle 1 showed poor compliance with only about 50% patients being prescribed appropriate intravenous fluid volumes. FY1’s completing the survey scored 54% on average. Often previous fluid prescription was copied. Cycle 2 showed some improvement in appropriate volumes and choice of maintenance fluids prescribed, and better survey score of 64%. There was also improvement on the understanding of daily fluid and electrolyte requirement from the FY1 cohort. Conclusions We suggest implementing varied educational approach to improve on fluid prescribing and patient outcomes in hospital.