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  • Title: Improving surgical intravenous fluid management: a controlled educational study.
    Author: Gnanasampanthan V, Porten L, Bissett I.
    Journal: ANZ J Surg; 2014 Dec; 84(12):932-6. PubMed ID: 24990455.
    Abstract:
    BACKGROUND: This study aims to measure whether the introduction of a multifaceted, evidence-based, educational intervention will improve both intravenous (i.v.) fluids prescribed by doctors and administrated by nurses. METHODS: A daily baseline audit of i.v. fluid prescription and administration for colorectal inpatients was carried out at two Auckland teaching hospitals over 4 weeks. The educational intervention was then administered at hospital 1, while at hospital 2 nurses and junior doctors were merely informed of the audit. The educational intervention included a lecture, multiple posters around the wards and pocket i.v. fluid protocols for junior doctors. Data collection continued for a further 4 weeks at both sites. RESULTS: The study included 513 days of i.v. fluids received by 109 patients at the two sites. At hospital 1 following the intervention, there was an improvement in the number of correct prescriptions of maintenance i.v. fluids from 21% to 62% (P < 0.001). There were also improvements in the number of patients who received correct administration of i.v. maintenance fluids from 26% to 57% (P < 0.001), gastric loss i.v. replacement from 61% to 93% (P < 0.001) and bowel loss i.v. replacement fluids from 59% to 85% (P = 0.004). None of these measures improved at hospital 2. CONCLUSION: At baseline, both prescription and administration of i.v. fluids were poor. A multifaceted educational intervention, involving teaching sessions with handouts, pocket-sized cards and posters visible on the wards, has brought improvements to both the prescription and administration of i.v. fluids in patients managed by colorectal surgeons.
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