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Physician awareness of fluid volume administered with intravenous antibiotics: a structured interview-based study
Jaleh Aghaie1, Marianne Lisby1,2, Marie Kristine Jessen1,3
1Research Center for Emergency Medicine, Department of Clinical Medicine, Aarhus University Hospital, Aarhus University, Aarhus, Denmark.
Objective:
Fluids administered as drug diluents with intravenous (IV) medicine constitute a substantial fraction of fluids in inpatients. Whether physicians are aware of fluid volumes administered with IV antibiotics for patients with suspected infections is unclear. Moreover, whether this leads to adjustments in 24-hour fluid administration/antibiotics is unknown.
Methods:
This cross-sectional interview-based study was conducted in three emergency departments. Physicians were interviewed after prescribing around-the-clock IV antibiotics for ≥24 hours to patients with suspected infection. A structured interview guide assessed the physicians' awareness, considerations, and practices when prescribing IV antibiotics. The 24-hour antibiotic fluid volume was calculated.
Results:
We interviewed 100 physicians. The 24-hour fluid volume administered with IV antibiotics was 400 mL (interquartile range, 300-400 mL). Overall, 53 physicians (53%) were unaware of the fluid volume administered with IV antibiotics. Moreover, 76 (76%) did not account for the antibiotic fluid volume in the 24-hour fluid administration, and 96 (96%) indicated that they would not adjust prescribed fluids after receiving information about 24-hour antibiotic fluid volume administered for their patient. No comorbidities associated with fluid intolerance were the primary reason for not adjusting prescribed fluids/ antibiotics. Approximately 79 (79%) opted for visibility of fluid volumes administered with IV antibiotics in the medical record.
Conclusion:
The majority of physicians were unaware of fluid volumes administered as a drug diluent with IV antibiotics. The majority chose not to make post-prescribing adjustments to their planned fluid administration; they regarded their patient as fluid tolerant. The physicians opted for visibility of fluid volumes administered as diluents during the prescribing process.
Insights
Most physicians are unaware of intravenous (IV) antibiotic fluid volumes. They do not adjust 24-hour fluid administration based on these diluent volumes, often assuming patients are fluid tolerant.
Area of Science:
- Internal Medicine
- Clinical Pharmacy
- Critical Care Medicine
Background:
- Intravenous (IV) fluids administered as drug diluents represent a significant portion of inpatient fluid intake.
- Physician awareness of fluid volumes from IV antibiotic diluents is not well understood.
- The impact of this awareness on fluid and antibiotic management strategies remains unclear.
Purpose of the Study:
- To assess physician awareness of fluid volumes administered with IV antibiotics.
- To determine if this awareness influences 24-hour fluid administration or antibiotic prescribing practices.
- To evaluate physician preferences for fluid volume visibility in medical records.
Main Methods:
- A cross-sectional, interview-based study involving 100 physicians in three emergency departments.
- Physicians were interviewed after prescribing continuous IV antibiotics for suspected infections.
- A structured guide assessed awareness, considerations, and practices; 24-hour antibiotic fluid volumes were calculated.
Main Results:
- 53% of physicians were unaware of the 24-hour fluid volume from IV antibiotics (median 400 mL).
- 76% did not account for antibiotic fluid volumes in total 24-hour fluid administration.
- 96% would not adjust prescribed fluids, citing assumed patient fluid tolerance; 79% desired visibility of diluent volumes.
Conclusions:
- A majority of physicians lack awareness regarding fluid volumes used as diluents for IV antibiotics.
- Most physicians do not adjust fluid administration post-prescription, assuming fluid tolerance.
- Physicians expressed a preference for increased visibility of diluent fluid volumes during the prescribing process.
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