Paterson-Brown, S.

Powell, A.G.M.T.

English

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FY1 doctors still poor in prescribing intravenous fluids

A. G. M. T. Powell

S. Paterson-Brown

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Enlighten – Research publications by members of the University of Glasgow http://eprints.gla.ac.uk        Powell, A.G.M.T., and Paterson-Brown, S. (2011) FY1 doctors still poor in prescribing intravenous fluids. British Medical Journal, 342 . d2741. ISSN 0959-535X   Copyright © 2011 BMJ Publishing Group Ltd.   A copy can be downloaded for personal non-commercial research or study, without prior permission or charge.  The content must not be changed in any way or reproduced in any format or medium without the formal permission of the copyright holder(s)  When referring to this work, full bibliographic details must be given.     http://eprints.gla.ac.uk/53209/        Deposited on: 24th January 2013   SAFETY THROUGH EDUCATIONFY1 doctors still poor in prescribing intravenous fluidsArfon GMTPowell clinical research fellow1, Simon Paterson-Brown consultant surgeon and honorarysenior lecturer 21Academic Unit of Surgery, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow Royal Infirmary, Glasgow G4 0SF,UK; 2Royal Infirmary Edinburgh, Edinburgh, UKThe British consensus guidelines on intravenous fluid therapyfor adult surgical patients (GIFTASUP) were developed in2008.1 2 They provide recommendations on patient assessmentand intravenous fluid prescribing in surgical patients.We undertook a questionnaire study assessing knowledge andconfidence along with the use of these guidelines in 33foundation year 1 (FY1) doctors in their first post. Generalknowledge about intravenous fluid administration was poor,with 16 (49%) scoring only 2 out of 5, five (15%) scoring 3 of5, and two (6%) scoring 4 of 5. Confidence was poor, with mostdoctors scoring 3 out of 5 for prescribing intravenous fluids,fluid challenge, and adding potassium to a fluid regimen (52%,52%, and 46% respectively). Clinical parameters suggested byGIFTASUP to assess fluid status were poorly used, and onlypulse, blood pressure, and urine output were used regularly(79%, 85%, and 88%, respectively). Only half of doctors statedthat they used blood results, comorbidities, and jugular venouspressure to help prescribe intravenous fluids.This study has formally shown what many senior doctors haveknown for some time: that FY1 doctors in their first post havean alarmingly poor understanding of the content andadministration of intravenous fluids commonly given to surgicalpatients and the indications for using different regimens.Although these findings have been reported previously, thedeficiencies remain and might explain the incidence of fluidoverload and iatrogenic pulmonary oedema in surgical patients.3-5The findings reflect badly on undergraduate medical education,and the problem is probably widespread. Understanding thephysiological changes in various clinical states and theimplications for intravenous fluid prescribing must assumegreater importance in undergraduate and postgraduate medicaleducation.Competing interests: None declared.1 Powell-Tuck J, Gosling P, Lobo DN, Allison SP, Carlson GL, Gore M, et al. Britishconsensus guidelines on intravenous fluid therapy for adult surgical patients—GIFTASUP.2008. www.bapen.org.uk/pdfs/bapen_pubs/giftasup.pdf.2 Powell-Tuck J, Gosling P, Lobo DN, Carlson GL, Allison SP, Gore M, et al. Authors ofguideline respond. BMJ 2009;339:b3030.3 Lobo DN, Dube MG, Neal KR, Simpson J, Rowlands BJ, Allison SP. Problems withsolutions: drowning in the brine of an inadequate knowledge base. Clin Nutr2001;20:125-30.4 Walsh SR, Walsh CJ. Intravenous fluid-associated morbidity in postoperative patients.Ann R Coll Surg Engl 2005;87:126-30.5 Lowell JA, Schifferdecker C, Driscoll DF, Benotti BN, Bistrian BR. Postoperative fluidoverload: not a benign problem. Crit Care Med 1990;18:728-33.Cite this as: BMJ 2011;342:d2741arfonpowell@doctors.org.ukReprints: http://journals.bmj.com/cgi/reprintform Subscribe: http://resources.bmj.com/bmj/subscribers/how-to-subscribeBMJ 2011;342:d2741 doi: 10.1136/bmj.d2741 Page 1 of 1LettersLETTERS

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FY1 doctors still poor in prescribing intravenous fluids

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