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Learning to prescribe intravenous fluids: A scoping review
Richard F R McCrory1,2, Gerard Joseph Gormley3, Alexander Peter Maxwell4
1Centre for Medical Education, Queens University Belfast, Belfast, Northern Ireland, UK. rmccrory02@qub.ac.uk.
Perspectives on Medical Education
|November 10, 2017
Summary
Medical graduates struggle with prescribing intravenous (IV) fluid therapy, leading to patient harm. Current education is insufficient, highlighting the need for better understanding of real-world IV fluid prescribing practices.
Area of Science:
- Medical Education
- Clinical Skills
- Patient Safety
Background:
- Prescribing intravenous (IV) fluid therapy is a fundamental skill for graduating doctors.
- Medical graduates frequently report feeling unprepared to prescribe IV fluids, contributing to patient harm.
- This review examines the current evidence on how junior doctors prescribe IV fluid therapy and their learning processes.
Purpose of the Study:
- To map the existing evidence on junior doctors' practices and education regarding IV fluid therapy prescription.
- To identify gaps in understanding the 'whole task' of IV fluid prescribing in authentic clinical settings.
Main Methods:
- A scoping review was conducted, searching five electronic databases and grey literature from 1994 to June 2016.
- 63 articles were selected for analysis, focusing on IV fluid prescribing in adult generalist settings.
- Findings were categorized using the WHO Guide to Good Prescribing.
Main Results:
- Most studies focused on the doctor's perspective of IV fluid prescribing.
- Junior clinicians found it difficult to view IV fluid prescribing as a complete task in real work environments and lacked adequate support.
- Educational interventions primarily concentrated on theoretical knowledge of fluid and electrolyte balance, not the practical execution of prescribing.
Conclusions:
- Current understanding of IV fluid prescribing as an integrated skill and its real-world performance is incomplete.
- Existing educational approaches for IV fluid prescribing are inadequate for ensuring safe and effective practice.
- A clearer understanding of how healthcare professionals prescribe IV fluids in practice is essential for improving education and patient safety.
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