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Surgical Fluid Prescribing: When Are the Last Orders?
Robert A Bennett1, George E Fowler1
1General Surgery, Royal Devon and Exeter NHS Foundation Trust, Exeter, GBR.
Cureus
|January 7, 2021
Summary
Foundation Year 1 doctors (FY1s) frequently receive fluid review requests, often initiated by nurses during shift changes. Improving education and multidisciplinary fluid prescribing practices can reduce inappropriate out-of-hours requests.
Area of Science:
- Medical Education
- Patient Safety
- Surgical Care
Background:
- Inappropriate fluid prescriptions contribute to surgical patient morbidity and mortality.
- Foundation Year 1 doctors (FY1s) often exhibit poor fluid prescribing knowledge and habits.
Purpose of the Study:
- To analyze the patterns and timing of out-of-hours (OOHs) fluid review requests in surgical patients.
- To identify factors contributing to inappropriate fluid prescribing by FY1s.
Main Methods:
- Retrospective observational study of 1,283 surgical fluid review requests over one year.
- Data extracted from an out-of-hours electronic task record system at a district general teaching hospital.
Main Results:
- 95.7% of fluid reviews were assigned to FY1s, and 92.3% were requested by nurses.
- Requests peaked at 1900 and 2400, coinciding with nursing handovers and midnight fluid chart changes.
Conclusions:
- Nursing staff frequently request fluid reviews during shift changes and at midnight.
- Interventions targeting ward rounds and multidisciplinary education can improve fluid prescribing and reduce OOHs requests.
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