Intravenous fluid prescribing practices by foundation year one doctors - a questionnaire study

Area of Science:

• Medical Education
• Clinical Practice
• Patient Safety

Background:

• Foundation Year Ones (FY1s) are junior doctors in the UK.
• FY1s often prescribe intravenous fluids to patients not under their regular care during on-call or out-of-hours shifts.
• This practice requires careful decision-making due to the doctor's unfamiliarity with the patient.

Purpose of the Study:

• To investigate the intravenous fluid prescribing practices of FY1s.
• To understand the decision-making processes employed by FY1s when prescribing intravenous fluids to unfamiliar patients.
• To identify variations in practice and decision-making among FY1s during on-call or out-of-hours cover.

Main Methods:

• A questionnaire survey was conducted.
• The survey focused on the practices of FY1s during on-call and out-of-hours ward cover.
• Participants included FY1s from five National Health Service (NHS) hospitals in England and Scotland.

Main Results:

• All 149 FY1s responded to the survey.
• While most FY1s checked patient's urea and electrolytes (72%), fluid balance (58%), and observation charts (80%), less than half read medical notes (43%) or performed clinical examinations (16%).
• Most FY1s (94%) checked urea and electrolytes when prescribing potassium, but significant variations exist in other aspects of prescribing practice.

Conclusions:

• The study revealed significant variations in FY1s' intravenous fluid prescribing practices and decision-making for unfamiliar patients during on-call periods.
• These practice variations highlight a need for targeted interventions.
• Medical schools, foundation schools, and NHS hospitals should address these variations to improve patient care and safety.